Endoscopic sphincterotomy may be the treatment of choice in type I
sphincter of Oddi dyskinesia, but in type II
dyskinesia the results are controversial, the complication rate may be high, and technically
endoscopic sphincterotomy is not always possible.
Nifedipine has been observed to relax the sphincter of Oddi and to enhance biliary drainage, especially in patients suffering from
sphincter of Oddi dyskinesia. Therefore,
nifedipine (10 mg, three times a day) was compared with placebo in treating suspected type II
sphincter of Oddi dyskinesia in 13 cholecystectomized patients in a 16-wk study period in a double-blind "cross-over" manner. Daily, the patients completed a diary of the pains, need of
pain medication, and
headache. Clinical examinations and blood tests for liver chemistry were performed at 4-wk intervals.
Nifedipine diminished the number of days on which the patients experienced biliary-type pains (10.5 +/- 8.6 vs. 5.8 +/- 4.1, p = 0.042), and the number of days when
pain medication was needed was slightly reduced (5.2 +/- 3.9 vs. 3.6 +/- 3.2, p = 0.066). After the study, one patient preferred to undergo
endoscopic sphincterotomy, eight patients preferred to continue with
nifedipine, and four patients preferred
analgesics only. Liver chemistry remained unchanged in this study. Also heart rate, blood pressure, and the number of days of
headache were not different between the
nifedipine and placebo periods. We conclude that
nifedipine is well tolerated in patients with type II
sphincter of Oddi dyskinesia, and
nifedipine may be tried for reducing the number of painful days and need for
analgesics in patients with this disorder.