Sphincter of Oddi Dysfunction, Symptoms, Diagnosis and Treatment

sphincter-of-Oddi-dysfunction-treatmentSphincter of Oddi dysfunction (SOD) is a functional gastrointestinal abnormality which commonly causes acute pancreatitis. Even without the unfortunate occurrence of acute pancreatitis Sphincter of Oddi dysfunction is characterized by pancreatobiliary pain that can be debilitating and impair the patients quality of life.

As far as I can tell from reading dozens of articles nobody knows for sure what causes this functional abnormality. Sphincter of Oddi dysfunction is associated with gallbladder disease, gallstones and ironically those who have the gallbladder removed seem to be more prone to Sphincter of Oddi dysfunction. The majority of SOD patients are female, 30 – 50 years of age; however, that certainly doesn’t mean that males are immune to this condition. Close to 20% of the lucky folks with Sphincter of Oddi dysfunction are male.

What Is The Sphincter of Oddi?

Sphincter of Oddi Dysfunction
Sphincter of Oddi

Imagine a strong donut, a muscular valve that surrounds the exit of the bile and pancreatic ducts, into the duodenum, right at the papilla of Vater. That muscular valve is called the Sphincter of Oddi. The SO is normally closed for business. It opens only in response to the flow of digestive juices after a meal so that those digestive juices can enter the duodenum and help digest the foods eaten for intestinal absorption to occur.

The mechanism of Sphincter of Oddi dysfunction, why it occurs, is not well-known. The theory is that the sphincter goes into a spasm causing a temporary back-up of biliary and pancreatic juices.

Sphincter of Oddi Dysfunction Symptoms

The back-up of digestive juices we were talking about previously results in abdominal pain. The pain can be mild, moderate or severe, even debilitating. Unfortunately this back-up of digestive juices can and commonly does cause acute pancreatitis.

Symptoms of SOD include:

  • abdominal pain
    • located in mid- or right-upper abdomen
    • might also be felt in the back and shoulders
    • can last anywhere from several minutes to several hours
    • can be a mild, dull throbbing pain, or …
    • can be so severe that the individual is incapacitated
  • Nausea with or without vomiting
  • Fever
  • Chills
  • Diarrhea
  • jaundice
    • prolonged obstruction may result in bile leaking back into the blood stream
    • results in abnormalities of the liver function tests
    • can result in a yellowish discoloration of the eyes and skin

The above symptoms can come and go. They can be mild one time and severe the next.

 Diagnosing Sphincter of Oddi Dysfunction

sphincter of oddi dysfunctionChances are that unless you have a really sharp doctor you’ll suffer for months, even years, playing let’s find the clue, especially if you are male, have NOT had any sign of gallbladder disease or had gallbladder disease and underwent cholescystectomy (gallbladder surgery). If on the other hand if you are female, between 30 and 50 and have had your gallbladder removed your chances of having your doctor’s light bulb flash on Sphincter of Oddi dysfunction is much higher.

When Sphincter of Oddi dysfunction is suspected by your doctor, he or she will most likely run tests to check for other conditions that might be causing your abdominal pain. It is important to rule out biliary cancer, cancer of the pancreas, liver, peptic ulcer or stones in the ducts that carry bile from the liver. In some cases even heart conditions can cause pain that seems to be originating from the abdomen.

Initial investigations:

  • Blood is drawn to check on liver and pancreas tests (particularly alkaline phosphatase, transaminases and amylase/lipase).
  • Standard ultrasound and CT scans are used to look for structural causes, but are not completely accurate.
  • When these are unrevealing, most experts recommend other imaging procedures, such as Magnetic Resonance Cholangiopancreatography (MRCP) and Endoscopic Ultrasound (EUS). One of these should be used before considering more invasive, risky procedures like ERCP with Sphincter of Oddi manometry to check sphincter pressure.
  • Another test (HIDA scanning) is sometimes used to detect poor emptying of the bile duct due to sphincter activity, and BOTOX injection into the sphincter has been explored as a test for over-activity.

Sphincter of Oddi Dysfunction Treatment

sphincter of Oddi dysfunctionSphincter of Oddi dysfunction treatment can be a crap shoot. In those people who do not have severe symptoms sphincter of oddi dysfunction treatment may be drugs that reduce pain and help prevent sphincter of oddi spasms. In others with severe symptoms the doctor may refer them to a surgeon for a procedure called a sphincterotomy.

There are 3 categories of Sphincter of Oddi dysfunction, (1, 11, 111). Each category of Sphincter of Oddi dysfunction suggests certain forms of Sphincter of Oddi dysfunction treatment. I will give my unprofessional Sphincter of Oddi dysfunction treatment ideas (what I would do if I had SOD) that should probably never be used, especially without your doctors approval because let’s face it – I am not a doctor, not an expert, not even a highly educated quack!

What Is Sphincterotomy?

Sphincterotomy is a difficult, delicate procedure. To make a long story short they put you to sleep, run a tube (with a blade) down your throat, into your common bile duct, down past your pancreatic duct to the sphincter found at the enterance to your duodenum. Then the surgeon cuts your sphincter.  The video will show you what happens. Now this is a DUAL sphinchterotomy which includes doing the pancreatic duct as well which in my opinion (which isn’t and educated opinion) would almost guarantee or at least increase the probability, substanially, that the woman will later experience acute pancreatitis.

sphincter of oddi dysfunctionSphincterotomy carries a fairly high risk of complications. 5% – 15% of patients experience complication [1]. Acute pancreatitis (mild, moderate or severe) is one of the possible and most common complications. Other complications include hemorrhage, perforation, cholangitis, cholecystitis, death and various other issues. In one study of 2347 patients, 229 (9.8 percent) had a complication, including pancreatitis in 127 (5.4 percent) and hemorrhage in 48 (2.0 percent). There were 55 deaths from all causes within 30 days; death was directly or indirectly related to the procedure in 10 cases [3]. The sad part is that sphincterotomy only works on about 50% of those who have it done. In my opinion it is a dangerous crap shoot.

Of course, as always, if you have been diagnosed with Sphincter of Oddi dysfunction you need to determine what treatment is right for you. I need you to complete understand that I am NOT giving you advise. I’m giving you information along with my uneducated opinions. You need to do your own research and ask your doctor a lot of direct, pertinent questions. However …

If it were me I think I’d choose a safer route first, especially since SOD has been found to respond to a low fat diet just as do pancreatitis and gallbladder disease. I’d probably also use grape seed extract and grape fruit seed extract (or juice) not only to help relieve symptoms by decreasing any inflammation but to also help protect the pancreas from acute pancreatitis.

 

 

 

References:

1) Sphincter of Oddi dysfunction – Read here

2) Complications of Endoscopic Biliary Sphincterotomy – Read Here

3) Complications of endoscopic biliary sphincterotomy – Read here

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