One of the main issues in case of pathology of major duodenal papilla is a differential diagnostics of organic (papillostenosis) and functionl (spasm) dysfunctions of Oddi’s sphincter. Differential diagnostics of papillospasm and papillostenosis is quite difficult, especially on early stages of the diseases, based on the data of clinical and instrumental investigations. An optimal variant of treatment of papillospasm is a conservative one. Patients with such treatment show decrease of pain and vanishing of dyspeptic disorders. In case of papillostenosis a preference ought to be given to endoscopic operations: papillotomy or balloon dilatation. All such patients in the postoperative period should be given a conservative therapy. Authors consider that such a differential diagnostics and tactics of treatment are justified in 90% of cases and lead to improvement of patients or healing.