Most people don’t know about the sphincter of Oddi, but it’s an important muscle valve that controls the flow of digestive juices, bile and pancreatic juice, through ducts from the liver and pancreas, carrying it to the beginning of the small intestine. Sphincter of Oddi dysfunction is scenario where the sphincter doesn’t relax at the right time because of scarring or spasms. The back-up of the bile and pancreatic juices will then cause harsh abdominal pain.
Doctors will usually consider sphincter of Oddi dysfunction inpatients who have recurrent attacks of pain after the surgical removal of the gallbladder. There are more than a half a million of these surgeries performed per year in the United States; 10-2% of these patients will have continuing or recurring pains. Sphincter of Oddi dysfunction is also considered in select patients who have recurrent attacks of inflammation of the pancreas, also known as pancreatitis.
Around half of these patients will have findings in lab studies or imaging, such as blood test, ultrasound or CT scan, to suggest that there’s an abnormality, like a stone in the bile duct. The MRCP or magnetic resonance cholangiopancreatography is currently the most non-invasive test for checking on your biliary and pancreatic systems. Looking at patients’ histories and physical examination, along with other clinical data, doctors are able to sort the patients that have sphincter of Oddi dysfunction type 1 or 2. These categories will help guide the type of treatment for this disease.
The sphincter of Oddi is a muscular component that is part of the distal common bile duct, as well as the pancreatic duct; both the bile and pancreatic ducts get through the wall of the duodenum. There’s a condition referred to as sphincter of Oddi dysfunction, SOD, that is basically a biliary or pancreatic blockage caused by some kind of abnormality in the sphincter of Oddi. This condition has also been referred to as biliary spasm, sclerosing papillitis, and stenosis.
The history of SOD has never really been discussed in detail, as the information at hand on the condition because of the many variables on its history.
There was a one-year study on seven patients with type 2 SOD with unnatural sphincter of Oddi pressure. They all had biliary pain, abnormal liver tests or dilated bile duct. After the patients were treated with a sham procedure the symptoms of SOD continued; however, it toned down after sphincterotomy. Four years later, and the patients continue to be in good health. There were five other patients with type 2 SOD that did not want sphincterotomy. After four years, only two of them had somewhat of an improvement, while the other three showed none.
With patients that have type 3 SOD, the clinical courses become more unpredictable with the sphincterotomy or sham procedures. There was one case with 11 patients that were observed for a couple years after sphincterotomy. Four showed improvements while the other seven showed no signs of improvement. At this stage, the results cannot be anticipated accurately enough.
The symptoms of sphincter of Oddi dysfunction will vary, but the most common symptom is a very evident abdominal pain, that may also include nausea or vomiting. An elevated liver or pancreatitis are also symptoms that you may have sphincter of Oddi.
The diagnosis of sphincter of Oddi starts with your doctor reviewing your medical history. A lab test may be ordered and you may have to do x-rays. If the physician suspects that you may have sphincter of Oddi, a process called sphincter of Oddi Manometry will be used to determine for sure if you have SOD. This particular procedure will be performed during an endoscopic procedure to study your bile and pancreatic ducts: ERCP. Sphincter of Oddi Manometry is a process that will be used for measuring the pressure of the sphincter of Oddi.
There are various methods that may be used to treat sphincter of Oddi. Your physician may give you medications to help in relaxing your sphincter of Oddi muscles, like anti-spasmotics. There may also be ERCP performed in order to help treat sphincter of Oddi. During the process of ERCP, there’s a thin tube that goes down your esophagus, stomach and your small bowel to get to the sphincter of Oddi. Depending on your doctor, there may be a small incision made in the sphincter of Oddi, a stent placed, or medication that’s injected. In more severe cases of sphincter of Oddi dysfunction, surgery may have to be performed.