Sphincter of Oddi Dysfunction | Q&A

Sphincter of Oddi Dysfunction | Q&A

October 24, 2019 18 By William Morgan


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Sphincter of Oddi dysfunction
is a very controversial entity.
The Sphincter of Oddi is a small
muscle that is located at
the end of the bowel duct,
and the pancreatic duct.
When this muscle
becomes dysfunctional,
the patient will have
symptoms of pain, nausea.
The reason that
is controversial,
is that many people even doubted
the existence of a Sphincter
of Oddi, because this
muscle is really small.
And it was just felt to be
part of the small intestine.
However Lou Gehrig Orly who
the muscle is named after
discovered that this muscle
was a separate entity.
Following that there was a great
debate whether this sphincter
could become dysfunctional.
And for many years patients who
suffered from sphincter Ody
dysfunction had pain.
But there was no good
way to diagnose this.
And many of these patients were
thought to have a psychiatric
disorder.
Were told by their physicians to
seek a psychiatrist because all
the tests were normal.
However, in the last
two decades,
medicine has discovered ways
of diagnosing this entity.
And we have now sophisticated
tests to confirm the diagnosis
of sphincter Oddi dysfunction.
These tests can be non-invasive
such as imaging studies or
more invasive, in which we
perform endoscopy and actually
record pressure measurements
of the sphincter of Oddi.
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Patients who have sphincter
Oddi dysfunction can manifest
symptoms in several ways.
The most common way
is to have pain,
especially after having
gallbladder surgery.
The typical patient will say,
I had my gallbladder removed and
the pain is still there.
Or they will say,
I had my gallbladder removed.
My pain went away, but
the same pain is now back.
And this syndrome is known as
postcholecystectomy syndrome.
That is pain after having
your gallbladder removed.
And this is the most
common way for
patients to present,
pain after gallbladder surgery.
In some patients, with sphincter
of Oddi dysfunction they may
have recurrent pancreatitis.
Because a sphincter encircles
the end of the pancreatic duct.
And if there is an abnormal
functioning of the pancreatic
sphincter, patients
will get pancreatitis.
So that’s the second most common
way that these patients present.
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So, patients who have
sphincter of Oddi dysfunction
suffer with chronic
abdominal pain.
The pain is usually after meals,
especially fatty meals.
Many of these patients
will already have
their gallbladder removed.
These are some of the clues that
this could be sphincter of Oddi
dysfunction.
The pain is usually on the right
upper side of the abdomen.
But it can also be in the upper
middle part of the abdomen and
the pain may also
radiate to the back.
Many of these patients will go
through multiple imaging tests
including CT scans and MRIs and
these tests will be normal.
If a patient has
a consolation of a normal.
Imaging studies, but
persistent abdominal pain
especially after meals,
then one has to think about
sphincter of Oddi dysfunction.
The patients who are affected
sy sphincter of Oddi dysfunction
are the same patients who
have gallbladder disease.
That is most commonly women
in their middle ages.
The most common way that
patients will present
is that you’ll have a middle
aged woman who says,
my gallbladder was removed, but
I still have the same pain as
before gallbladder surgery.
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The diagnosis of sphincter of
Oddi function is very difficult.
They are noninvasive tests
such as baileocentrigriphy.
Baileocentrigriphy is
a nuclear medicine study
that looks at drainage
from the bailery system.
The best way, however,
to diagnose sphincter of Oddi
function is an endoscopic test
called an ERCP with monometry.
This test is very accurate but
associated with
significant risk.
The most important risk
is pancreatitis, if
this were to occur the patient
would have abdominal pain,
nausea and vomiting that would
require hospital admission.
The risk of pancreatitis after
ERCP manometry is very high,
up to 20% of patients
in some studies,
May develop pancreatitis
following ERCP.
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By far, the most common cause of
pancreatitis are gallstones and
alcohol.
However in a sub-group of
patients which there are no
identifiable causes
of pancreatitis.
One has to consider sphincter
Oddi dysfunction and
this is because the sphincter
also encircles the end of
the pancreatic duct.
If the sphincter
becomes dysfunctional
then patients may re-suffer
from recurrent pancreatitis
of undetermined edology.
So in my practice I will
see patients who have.
Recurrent pancreatitis of
that the cause has
not been identified.
And in these
patients we look for
sphincter of oddi dysfunction
using endoscopic test.
And if it’s there then we can
perform treatment which I
mentioned before is
endoscopic sphincterotomy.
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The best way to treat sphincter
of oddi dysfunction is
endoscopically.
That is,
we perform an endoscopic
procedure called an ERCP and
then during the ERCP, we make
an incision into the muscle.
This is called an endoscopic
sphincterotomy.
If the patient has all
the right criteria for
Sphincter Oddi function,
about 90% of patients will have
resolution of these symptoms.
However, recently there has been
controversy over this technique
of sphincter oddi telemetry.
And even if some patients have
abnormal studies only 50% of
patients may respond to
endoscopic sphincterotomy.
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