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Sphincter of Oddi Dysfunction

Sphincter of Oddi Dysfunction

Sphincter of Oddi dysfunction refers to a disorder of the sphincter in your upper intestine. A sphincter is any muscle in your body that controls an opening and closing.

Anatomy of the sphincter of Oddi
Anatomy of the sphincter of Oddi (Click to Enlarge)

The sphincter of Oddi controls the flow of bile and pancreatic juice from the pancreas into the small intestine. It also prevents bowel contents from backing up into the pancreatic and bile ducts.

Biliary-type pain results from dysfunction of the sphincter of Oddi; A: stenosis of the sphincterof Oddi; B: dysfunctional muscle.
Biliary-type pain results from dysfunction of the sphincter of Oddi; A: stenosis of the sphincterof Oddi; B: dysfunctional muscle. (Click to Enlarge)

Sphincter of Oddi Dysfunction Symptoms

The major symptom of sphincter of Oddi dysfunction is abdominal pain. The pain may be accompanied by:

  • Nausea and/or vomiting

  • Back and shoulder pain

Rarely, patients experience fever, chills and jaundice.

Sphincter of Oddi Dysfunction Diagnosis at Johns Hopkins

Gastroenterologists at Johns Hopkins are at the forefront of research in the diagnosis and treatment of sphincter of Oddi dysfunction. Our physicians have decades of experience and use the most advanced diagnostic technology.

Our comprehensive, multidisciplinary approach means we see the whole picture, so we can accurately diagnose your sphincter of Oddi dysfunction.

Sphincter of Oddi Dysfunction Diagnostic Procedures

Sphincter of Oddi dysfunction is often diagnosed after other more serious diseases have been ruled out. Many of the diagnostic procedures you may undergo are for the purpose of ruling out tumors and stones.

A diagnosis begins with a comprehensive physical exam during which you describe your symptoms and medical history. Taking a complete medical history is a very important part of the diagnosis. We will use blood labs to check your liver function. If you recently underwent a cholecystectomy and are experiencing abdominal pain, this is a sign that you may have sphincter of Oddi dysfunction.

Other diagnostic procedures include:

Biliary Scintigraphy

A biliary scintigraphy is a noninvasive radiologic test to help diagnose sphincter of Oddi dysfunction. Doctors at Johns Hopkins developed an innovative method of scoring patients, called the Hopkins SOD score. Our method is now used in other hospitals around the country.

During a biliary scintigraphy, you receive an intravenous injection of a radioactive chemical. The chemical follows the path of the bile. Your doctor will use a special camera that senses radioactivity to obtain images of your gallbladder and any bile leaks.

Ultrasound

An ultrasound uses powerful sound waves to create detailed images of the inside of your body. Studying these images can determine if there is a bile flow obstruction or other dysfunction.

Magnetic Resonance Cholangiopancreatography (MRCP)

An MRCP is a specialized magnetic resonance imaging (MRI) scan that is used so the pancreatic ducts can be visualized.

Endoscopic Retrograde Cholangiopancreatography (ERCP)

An ERCP is used to see the bile and pancreatic ducts. During this procedure:

  1. A special side-viewing endoscope called a duodenoscope is used.

  2. This scope is specially designed so the necessary accessories can be placed into the bile and pancreatic duct.

  3. A catheter is used to inject dye into the ducts.

  4. An X-ray obtains images of your pancreatic and biliary ducts.

ERCP and Sphincter of Oddi Manometry

Sphincter of Oddi manometry is the gold standard for diagnosing sphincter of Oddi dysfunction. It is more invasive than other tests, such as the biliary scintigraphy, but can provide a definitive diagnosis.

This procedure determines if your sphincter of Oddi is functioning normally. During the procedure, your doctor inserts a small plastic tube into your pancreatic or bile ducts near the sphincter of Oddi. This tests how well the sphincter opens and closes.

Currently, doctors at Johns Hopkins are currently conducting an investigation comparing biliary scintigraphy and sphincter of Oddi manometry. This research will help to determine which procedure will predict a patient’s response to treatment better.

A: Patient positioning and room set-up for sphincter of Oddi manometry; B: endoscopic view of manometry catheter in position.
A: Patient positioning and room set-up for sphincter of Oddi manometry; B: endoscopic view of manometry catheter in position. (Click to Enlarge)

Sphincter of Oddi Dysfunction Treatment at Johns Hopkins

The goal of treatment for sphincter of Oddi dysfunction is to reduce the pressure on the sphincter. This will improve the drainage of bile and pancreatic juices. Learn more about sphincter of Oddi dysfunction treatment at Johns Hopkins.

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