Biliary dyskinesia

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@Rene-uz3eb 2 жыл бұрын

6:59 placebo effect same or better than actual sphincterotomy, with only 25% complete success (no pain) in either case 9:59 SOD III (pain but no abnormalities) does not exist I would say all we know is that sphincterotomy does not work. It could be that it was disfunctioning, causing pain via bile backflow, or that the lack of a sphincter also causes pain. That could be because of foods entering the bile duct, or that the duct opening narrows as a reaction to removing the sphincter, to keep positive pressure to remove the possibility of backflow of food into the bile duct. Removing the gallbladder could also cause pain, because bile from properly working liver now has no gallbladder to store it, and the sphincter may not be calibrated to release enough bile during fasting conditions, resulting in filling up the bile tube and back flow into liver/pain. As a matter of fact, the sphincter is almost certainly NOT calibrated to release all the bile into the duodenum, because the whole point of the gallbladder is to store the bile. I'm saying that because from anatomy, the bile does not first go to the gallbladder but directly into duodenum during a meal. That means the bile must be backflowing into the gallbladder when the sphincter is closed between meals. Seems to be the only physiology that makes sense. So when there is no gallbladder, it keeps backflowing higher, into the liver. So my conclusion is that the removal of the gallbladder opens a whole can of worms that apparently can't be fixed 10:50 no convincing studies that sphincterotomy in a SOD II diagnosis (abnormalities) works, no operation similar improvements as operation. 15:40 I would guess that the cause if biliary dyskinesia (no abnormalities, intact gallbladder) is too much nitric oxide. Since the latter reduces motility of the sphincter of Oddi, this might cause too much bile to backflow into the gallbladder before all of it can be concentrated, resulting in increased bile fluid pressure by some time before the next meal 17:43 in many patients bd improves on its own (maybe ingesting LESS - sorry i said more before - arginine rich foods, so nitric oxide production by macrophages etc is reduced?) See also the paper Arginine intake is associated with oxidative stress in a general population, 2017 18:05 half of asymptomatic patients had 'abnormal' ejection fraction (so clearly ejection fraction is useless)

@MIMH92 Жыл бұрын

So are you suggesting to eat less nitric oxide rich foods? I am suspected of having SOD -10 years on and off pain about 3 times a year.. Normal ejection fraction however twice as long for the gallbladder to fill, no stones sludge on MRCP or EUS and CT. However during a flare up after 'c' I had elevated liver levels and a dilated bile duct- 8 months later liver levels are normal duct is normal pancreas gallbladder etc everything comes back normal but 24-7 constant pain in middle and upper right side. Docs can't figure it out. Thinking of trying your suggestion since nothing else is working... have u heard of studies of quercetin for SOD? Hope everyone suffering gets relief soon!

@Rene-uz3eb Жыл бұрын

@@MIMH92 Yes: I reviewed this again, I think the understanding of the sphincter of Oddi is severely lacking by current researchers, maybe they don’t want to see what they are doing by removing the gallbladder. A 1984 paper clearly states that the sphincter of Oddi has motility just like the GI tract etc, ie the smooth muscles propel fluid forward by rhythmic contraction. So excessive NO would not just cause relaxation of the sphincter, but probably is the cause of disfunction, e.g. spasm. Also excess NO in the GI can cause other problems like gastroparesis or acid reflux. Since there are lots of pain nerves in the biliary tract area, any abnormality probably causes pain by itself, such as SOD spasming, although that could also cause pressure increase in the biliary duct. Another explanation could be tissue ischemia around the biliary duct, this would also cause pain. Regarding quercetin, I see one paper where it is mentioned as having antispasmodic effect (as well as other herbs like chamomile) and used for GI problems, so yes that might be worthwhile to try if SOD is spasming rather than just slowed down.

@MIMH92 Жыл бұрын

@Rene thanks for replying! interesting that NO causes the sphincter of oddi to relax which I typically understood as a good thing although some research suggests it may cause attacks..Western medicine tell u to try antispasmodics and calcium channel blockers and natural medicine from experience suggested peppermint oil tablets and as topical. It's so hard to understand whether relaxing the sphincter of oddi is the way to go or if that actually makes things worse such as bile reflux as well as other issues. Magnesium is also suggested as an alternative but that is also categorised under NO/ arginine rich foods?! Perhaps the way to go is to think of motility as you mentioned...

@Rene-uz3eb Жыл бұрын

@@MIMH92 magnesium is required along the path of NO production, but I don’t think that’s the problem here, essential nutrients are needed for everything and starving of a nutrient hasn’t helped any condition I know. In blood vessel NO production, eating more arginine doesn’t increase NO apparently. So you could argue it also wouldn’t affect SOD and that I’m wrong here. It’s possible though that the arginine absorbed in the intestinal cells could locally generate NO affecting SOD. Or that the bacteria absorb it and create NO. Actually, gut bacteria create NO from nitrate. So maybe a reason to cut nitrates. Finally, acetylcholine is needed to activate and increase motility of the sphincter (NO reduces motility), so anticholinergic drugs might be to blame. I see your point about should SO be relaxed or vice versa to improve. Some reports talk about NO relaxing SO, while other talk about NO reduces activity of SO. I think the latter view is correct, since SO is a ‘motor’ like the intestines, repeatedly contracting to move contents forward. If you reduce activity (lack of acetylcholine, or too much NO), the sphincter of oddi is pumping less bile. So if the gallbladder says hey we need to push some bile but the SO says something else, that would be like turning on the garden hose with nozzle closed. Since the SO is exposed to the intestine, what happens there might override what the autonomous system is trying to do. The main reason why I suspect NO is that in many conditions resulting in too much ROS production, also too much NO results, which would definitely have a impact on the SO. My arginine angle might be wrong though, since it’s just a needed nutrient, and in studies it’s simply a way to control NO production which wouldn’t be true irl. With this additional thought maybe cutting nitrates, checking anticholinergics, and blood flow, are the best shots.

@MIMH92 Жыл бұрын

@Rene I think you are spot on regarding the hose analogy between the sphincter of oddi and gallbladder. Reviewing my HIDA scan indicated a ejection fraction of 89% without any stones/sludge. Some papers out there indicate that this hints to a hyperkinetic gallbladder... no one ever told me this. The gold standard I was told was to remove the gallbladder. However, like you mentioned this would then just push all the bile up into the liver since the sphincter of oddi is lacking motility and can't push the bile out.. it makes sense for the motility to be the issue not the gallbladder itself. Something is causing it to inflame (bile or stones)..could an option be choline supplementation? Grapeseed extract? Although both are said to stimulate the production of nitric oxide

@caressapotter6834 Жыл бұрын

So I was diagnosed with this in January. My liver counts were in 1,000s+. I had a sonogram, CT Scan, MRI, lots of blood work. They talked about putting a stint in and clipping it. But they haven't done anything since my spell in January. I had another spell on February 24th, and they still have not done anything. I hope they can do something because the pains/spells are getting worse.