Doctor-Patient CommunicationDoctors often consider SOD in patients who experience recurrent attacks of pain after surgical removal of the gallbladder (cholecystectomy). More than half a million of these surgeries are performed annually in the United States, and 10–20% of these patients present afterwards with continuing or recurrent pains. SOD is also considered in some patients who suffer from recurrent attacks of unexplained inflammation of the pancreas (pancreatitis). Show
About half of these patients will have findings on laboratory studies or imaging (blood test, ultrasound, CT scan, or MRCP) to suggest a definite abnormality, such as a stone in the bile duct. MRCP (magnetic resonance cholangiopancreatography) is nowadays a good non-invasive test for checking on the biliary and pancreatic drainage systems. Based on patients histories, physical examinations, and other clinical data, doctors can categorize these patients as having SOD Types I and II. The categories help guide treatment of the disease. They are based on a system called the Milwaukee criteria. Learn more about doctor-patient communication TreatmentWhen symptoms are severe, standard treatment is to perform an endoscopic procedure called ERCP (endoscopic retrograde cholangiopancreatography). ERCP is a procedure for the examination or treatment of the bile duct and pancreatic duct. The procedure carries a risk of serious complications and is done under sedation by experts trained in the technique. It combines the use of x-rays and an endoscope that is passed down to the duodenum, where the bile duct and pancreatic ducts drain, and a dye that is injected into the ducts. An additional procedure, sphincter of Oddi manometry (SOM), involves passing a catheter into the bile and/or pancreatic duct during ERCP to measure the pressure of the biliary and/or pancreatic sphincter. It is considered the gold standard diagnostic modality for SOD. Treatment depends on what is found. It may often involve cutting the muscular sphincter (sphincterotomy) to remove any stones or to relieve any scarring or spasm of the sphincter. As noted above, a very important problem in this context is that these ERCP procedures carry a significant risk of complications. In particular, ERCP (with or without sphincter of Oddi manometry) can cause an attack of pancreatitis in 5–10% of cases. While most of these result in a few days in the hospital, about 1% of patients suffer a major attack, with weeks or months in the hospital. Sphincterotomy also carries a small risk of other severe complications such as bleeding and perforation, and the possibility of delayed narrowing of a duct (stenosis) due to scarring. Functional Sphincter of Oddi DysfunctionPatients with a similar pain problem, but who have little or no abnormalities on blood tests and standard scans (including MRCP), are categorized as having SOD Type III. The episodes of pain are assumed due to intermittent spasm of the sphincter. It is very difficult to effectively evaluate and manage patients with Type III SOD. Some physicians are skeptical of its existence, or assume that it is a part of a broader problem of a functional digestive disturbance such as irritable bowel syndrome. Because of the risks of ERCP, patients with suspected SOD III are usually advised to try medical treatments first. Some respond to the use of antispasmodic drugs and/or antidepressants that may help decrease pain. There have been studies of other medical therapies, such as calcium channel blocking drugs. Despite a few encouraging reports, these methods have not proven to be effective generally, and are not widely used. Patients who fail these approaches (at least those with severe symptoms) are usually advised to see specialists at referral centers. Further evaluation may involve additional or more specialized tests to help guide treatment options. Clinical Research StudyThe uncertainties in how best to diagnose and to treat “suspected” sphincter of Oddi dysfunction (and the risks involved) mandate further scientific investigation. The National Institutes of Health has recently funded an important study called “EPISOD” in 6 major Gastroenterology centers in USA. This study has completed Study results are available at this NIH webpage. The sphincter of Oddi is a muscular valve that plays a vital role in digestion. It controls the flow of bile and pancreatic juice. It opens and closes to let the juices flow from the liver and pancreas into the small intestine. If the sphincter doesn’t open at the right time, it can lead to a backup of digestive juices (bile and pancreatic juice),
resulting in severe abdominal pain. There are two main types of sphincter of Oddi dysfunction: Mild cases of sphincter of Oddi dysfunction can be treated with medications, but severe cases require a surgical procedure known as sphincterotomy. Sphincter of Oddi dysfunction can be caused by scarring, spasm, strictures, or relaxation of the valve. When this happens, the bile and pancreatic juice can't flow forward. This causes a backup of
digestive juices that causes severe abdominal pain. The sphincter of Oddi dysfunction symptoms can be mild or severe. They can also go away and appear suddenly. Some common sphincter of Oddi dysfunction symptoms include: If you are a
middle-aged woman without a gallbladder, visit your doctor as soon as you experience any of the symptoms. You should also know about three categories of sphincter of Oddi dysfunction:
The sphincter of Oddi dysfunction is mainly observed in women ages 30 to 50. Those who have had their gallbladders removed in surgery also have a higher risk of developing this condition. The doctor starts the checkup by checking if the abdominal pain is due to any other condition or not. This checkup also helps him to identify any serious health issues you may have. Potential problems
include pancreatic cancer, bile duct cancer, peptic ulcer disease, or stones in the bile ducts. In rare cases, some heart issues, including angina or ischemia, can also cause severe abdominal pain. The doctor then examines your sphincter of Oddi to ensure its normal working. The procedure is called sphincter of Oddi manometry (SOM). Before the examination, you
will be given medicine to relax. Then, the doctor will insert a small plastic tube near the sphincter of Oddi, either in the pancreatic or bile duct. This helps them see how well the valve is contracting and expanding. If you are in the category III sphincter of Oddi dysfunction, you may not be experiencing severe pain. In such cases, doctors opt for medical treatment and
prescribe some medications. Most people get better with the use of pain medications, which stop the spasms in the sphincter of Oddi. If your condition is in category I or II, where the pain is quite severe, your doctor may suggest an endoscopic procedure called endoscopic retrograde cholangiopancreatography (ERCP). During ERCP, the surgeon inserts an endoscope through the mouth into the duodenum. This is the area where the bile and pancreatic ducts drain. Then, doctors inject a dye into the ducts. Some doctors also perform sphincterotomy with ERCP. For sphincterotomy, the doctor will sedate you or put you to sleep with anesthesia. When the process starts, they will insert a thin instrument into your small intestine to cut the sphincter of Oddi. The surgeon will also make sure that your gallbladder (if it's not removed) or bile ducts don't have any stones. Sphincterotomy takes away a good part of the pain in most cases. After the procedure, you will feel relieved and may not experience other symptoms. Sphincterotomy is only performed, though, when the earlier medical treatment fails. The process poses a high risk of complications. About 5% to 15% of people experience complications, from mild inflammation in the pancreas to hemorrhage and perforation. In cases with severe complications, you may need to receive long-term medical care. How do you know if you have sphincter of Oddi dysfunction?Symptoms of sphincter of Oddi dysfunction
The pain may feel like a gallbladder attack. The pain may be in your upper abdomen and seem to spread into your right shoulder. You may also have nausea and vomiting. It can also cause recurrent pancreatitis.
Does sphincter of Oddi dysfunction go away?The sphincter of Oddi dysfunction symptoms can be mild or severe. They can also go away and appear suddenly. Some common sphincter of Oddi dysfunction symptoms include: Abdominal pain (can be severe or mild)
How do you fix a sphincter of Oddi dysfunction?In sphincter of Oddi dysfunction, the sphincter muscle does not open when it should, which causes a backup of digestive juices and severe pain in the abdomen. This condition is treated with medications or a procedure called a sphincterotomy.
How long do sphincter of Oddi attacks last?The pain lasts anywhere between 30 minutes to several hours and can be so severe that it wakes people from their sleep during the night. Consequently, this can have a massive impact on a person's everyday activities, and life in general.
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Sphincter of oddi dysfunction after gallbladder removal
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