{
  "abstract": "Introduction The management of functional biliary pain remains a clinical challenge. Historically, research has focused on invasive management such as sphincterotomy, but as with other disorders of the brain-gut axis there has been a growing use of neuromodulator drugs. However, there is a paucity of evidence regarding the prescription and efficacy of neuromodulators in this patient group. This systematic review aimed to evaluate the prescribing patterns, efficacy, and tolerability of neuromodulators in functional biliary pain disorders.Methods A systematic literature search of PUBMED, MEDLINE and Google Scholar databases identified articles describing the use of neuromodulators (including tricyclic antidepressants, Selective Serotonin Reuptake Inhibitors and Serotonin-norepinephrine reuptake inhibitors) in the management of functional biliary pain, Sphincter of Oddi dysfunction and functional biliary dyskinesia.Results The search identified 660 studies. Four were eligible for inclusion, with a total of 225 patients (88% female, median age; 45) . Across the four studies, choice of neuromodulator in functional biliary pain was varied, with amitriptyline being most frequently prescribed (n=144), followed by duloxetine (n=39). There was marked variability in agent selection, dosing and limited data on combination therapy. Three studies assessed therapeutic efficacy, with 34 of the 84 patients prescribed neuromodulators (40%) reporting symptomatic benefit, however evidence was limited and outcome measures were not standardised. Only one study reported adverse events, with 39% of patients describing side effects, most commonly nausea and fatigue.Conclusion Neuromodulators are an emerging therapeutic option for a presently underserved patient population with a challenging symptom burden. However, significant heterogeneity in study design, outcome and prescribing patterns exists; prohibiting data synthesis. Multicentre, large cohort studies are required to build on current evidence and formally investigate therapeutic options.",
  "authors": [
    {
      "affiliations": [
        "University Hospitals Birmingham NHS Foundation Trust, United Kingdom"
      ],
      "name": "Joshua Baxter"
    },
    {
      "affiliations": [
        "University Hospitals Birmingham NHS Foundation Trust, United Kingdom"
      ],
      "name": "Shyam Menon"
    }
  ],
  "title": "P427 The role of neuromodulators in the management of functional biliary pain disorders: a systematic review",
  "uid": "68d50711-7253-5863-a29b-37bf583fa5e5"
}