Sphincter of Oddi Dysfunction
What is the sphincter of Oddi?
The sphincter of Oddi refers to the smooth muscle that surrounds the end portion of the common bile duct and pancreatic duct. This muscle relaxes during a meal to allow bile and pancreatic juice to flow into the intestine.
What is sphincter of Oddi dysfunction?
Sphincter of Oddi dysfunction refers to the medical condition that results from the inability of the sphincter to contract and relax in a normal fashion. This may cause obstruction of bile flow resulting in biliary pain and obstruction to the flow of pancreatic juice, which can lead to pancreatitis.
What causes sphincter of Oddi dysfunction?
The cause of sphincter of Oddi dysfunction is unknown. Several theories have been proposed including the presence of microlithiasis (microscopic stones in the bile) and duodenal inflammation.
What are the symptoms of sphincter of Oddi dysfunction?
The symptoms of sphincter of Oddi dysfunction include recurrent attacks of upper right quadrant or epigastric abdominal pain. This pain is usually non-colicky and steady. The pain may be aggravated by meals, particularly fatty foods. Opiates may also worsen symptoms. Patients may present with a recurrence or persistence of pain after gallbladder removal.
Who is affected by sphincter of Oddi dysfunction?
Sphincter of Oddi dysfunction is usually seen in female patients who have had their gallbladders removed. Typically, patients range in age from 30 to 50 years.
How is sphincter of Oddi diagnosed?
Noninvasive tests include: (1) a blood test to measure liver and pancreatic enzymes; and (2) radiographic tests: quantitative hepatobiliary scintigraphy in which a radioactive isotope is injected into the bloodstream, and the uptake and clearance of the isotope from the liver and biliary tract are measured.
Endoscopic retrograde cholangiopancreatography (ERCP) is an endoscopic procedure used in diagnosis. During ERCP, an endoscope is inserted into the mouth and advanced to the duodenum to the opening of the bile and pancreatic ducts. Contrast is injected and measurements of ductal diameter and biliary and/or pancreatic drainage times are made. Sphincter of Oddi manometry is the gold standard to diagnose sphincter of Oddi dysfunction. It may be performed at the time of ERCP, and measures pressures using a triple lumen catheter and water perfusion. High pressures are indicative of sphincter dysfunction.
Can sphincter of Oddi be treated and if so, how?
Medical therapy may be considered in the initial treatment plans. This includes a low-fat diet, antispasmodics, non-addictive analgesics, nifedipine and nitroglycerin. Usually the side effects of these drugs limit their usefulness, and none of the drugs are specific to the sphincter of Oddi.
More invasive treatment modalities include: endoscopic injection of botulinum toxin (Botox) into the sphincter and endoscopic or surgical ablation of the sphincter of Oddi.
What is the cause of recurrent symptoms?
Recurrent symptoms usually occur if there is scarring of the incision made during endoscopic sphincterotomy or surgical sphincteroplasty.
What is the long-term outcome of sphincterotomy or sphincteroplasty?
Long-term relief of pain in patients who have undergone endoscopic or surgical procedures for sphincter of Oddi dysfunction may be demonstrated in up to 70 percent of patients.