What Is Sphincter of Oddi?
The sphincter of Oddi is a very small but power ring of muscle found at the junction where the tube that carry bile from the gallbladder and the tube that brings pancreatic juice from the pancreas meets.
Its function is to regulate the flow of these substances into the first part of the small intestine called the duodenum.
After meals, especially rich or fatty meals, your gallbladder contracts to release bile - that green bitter liquid that helps in breaking down or emulsifying fat in our food to aid its proper digestion. The sphincter of Oddi relaxes to allow the flow of bile into the duodenum. Any abnormality in the muscle affecting the proper relaxation of this muscle or sphincter causes the bile to accumulate and flow back until it becomes stagnant, leading to forceful contraction of the distended tube. The same problem could affect the flow of pancreatic secretions into the duodenum.
This causes severe cramping right upper abdominal pain.
The sphincter of Oddi dysfunction occurs if there is stiffness of the muscle ring at the junction where the common bile duct and the pancreatic duct meets.The resulting back up of secretions from the gallbladder and or pancreas that are unable to flow pass the the sphincter causes severe abdominal pain.
Sphincter of Oddi dysfunction or SOD for short, can occur on its own or after an operation to remove the gallbladder.
There are two types of SOD. They are:
Any of the above types of dysfunction could lead to one or both of the following conditions, causing pain:
The exact cause or causes of dysfunction of the sphincter of Oddi is not known. However, it is believed that chronic inflammation affecting the ducts and the muscle ring around the ducts could be responsible. Some other doctors believe that intermittent spasm from the muscle could be responsible.
The following are names used to described this same condition:
Pancreatitis, chronic gall bladder infection, inadvertent injury of the sphincter during surgery, diverticular disease of the duodenum close to the site of the sphincter of Oddi, and tumor affecting the sphincter are all possible causes of SOD.
This condition could occur in anyone and at any age. It is however more common in women in their 30s, 40s and 50s.
Symptoms of sphincter of Oddi dysfunction include:
So, if you suffer with a right upper abdominal or central upper abdominal pain that tends to come on after eating, and spreads to the right side or back, with associated nausea, it is important you see your doctor to send you for a scan to exclude gallstones. If the scan result comes back and says that everything is fine and there are no stones in your gallbladder, it is almost certain that you may be suffering with SOD or acalculous cholecystitis.
If you, on the other hand has had a surgery to remove your gallbladder but still suffer with the same type of pain that made you have the surgery in the first place, then it is almost certain that you are suffering with sphincter of Oddi dysfunction or postcholecystectomy syndrome. Request that you be sent for test to diagnose or exclude this condition.
The diagnosis of the dysfunction of sphincter of Oddi is usually based on a good description of the pattern of pain by the patient which would lead to your doctor requesting the appropriate test for this condition.
So if you suspect that you have this condition, take the time to write down exactly how the pain comes on, where it is, what you have noticed that makes it worse, does it spread anywhere, and what makes it better.
Also include any other symptoms that you may experience including whether you have chills and rigors, feels nauseated and actually vomits. Are you losing weight - not everyone would have all the symptoms listed above.
The tests for this condition include:
The SOD has been classified into three diagnostic and patient types, based on the difficulties that may be encountered with diagnosis, which in fact, relates to what is happening in the sphincter. They are:
The take home message here is that if you suspect that you have SOD and all other tests come back normal, if you can afford it and are happy to undergo a manometry test, request for one. It may be the only way of diagnosing your condition. Even if it comes back normal, your doctor may decide that you get treated to see if your symptoms would disappear and get your life back.
There are a number of treatment options available for treating SOD. They include:
This involves the use of certain types of medications that have the ability to relax the muscle ring or the sphincter of Oddi. Such medicines for sphincter oddi dysfunction include:
This involves the use of an endoscope to pass a balloon into the stiff muscle ring and blow it wide, stretching the muscle and opening it up. It is an invasive process, but no cutting is needed.
This is the best treatment available. Using an endoscope, a small nick is made on the tight muscle ring, making it more lax and able to allow the free flow of bile and secretions from the pancreas.
Do you have upper abdominal pain that tends to be worse after meals and your ultrasound scan result came back normal for gallstones? Or have you had your gall bladder removed and yet still having gall bladder pain? Could this be due to sphincter of Oddi dysfunction? Share your thoughts here!
We would love to hear from you.
Have you actually been diagnosed with SOD? What were your symptoms, what happened, and how did you get diagnosed? Was it easy to find out? What about treatment? Has it made any difference to your life? We would be very pleased to hear from you too. Please post your experience below:
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