What is Sphincter of Oddi Dysfunction?
What is an "oddi" dysfunction? I've had acute pancreatitis several times and now my doctors are looking into this "oddi." It's such a strange word, and I can't find a meaning for it.
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The disease you are describing is known as sphincter of oddi dysfunction (SOD). The sphincter of oddi is situated in the upper intestine, or duodenum, at the site where the pancreatic and bile ducts enter. Normally, this sphincter functions as a one-way valve to allow bile and pancreatic secretions to enter the bowel, while preventing the contents of the bowel from backing up into these ducts.
When the sphincter malfunctions, it becomes overly tight and does not allow adequate drainage of the pancreatic and bile ducts. The result is a pressure build-up in the ducts, leading to recurrent episodes of pancreatitis or biliary pain mimicking gallstone disease.
SOD is an uncommon disease, so it often takes a while for the diagnosis to be made. Typically, patients who suffer from biliary colic pain or recurrent pancreatitis are investigated for gallstone disease, and many are sent to surgery for gallbladder removal. In most people, gallstones are indeed the causative factor and the pains do not recur. In a small minority of patients, however, the pain continues. It is in these patients that further investigations are done, specifically to evaluate for SOD.
The diagnosis of SOD is suggested by the typical pain or pancreatitis, such as you have experienced, along with lab evidence of pancreatic inflammation and/or abnormal liver enzymes. The diagnostic test of choice is a pressure study (manometry) of the sphincter. Manometry is done with a catheter that is passed into the sphincter through an endoscope that has been placed into the upper intestine, or duodenum. If pressure recordings suggest SOD, proper therapy involves an endoscopic cutting of the sphincter (sphincterotomy). Most patients with SOD have excellent results after sphincterotomy.
It must be noted that manometry of the sphincter is a very specialized procedure that should only be performed by expert endoscopists because it can increase the risk of pancreatitis. In addition to this risk, sphincterotomy for SOD can also sometimes result in perforation of the bowel. Thus, if your doctors are considering SOD as your diagnosis, you should be sure to check that the gastroenterologist caring for you has sufficient endoscopic experience both in diagnosing this condition and in treating it.
by Ronen Arai
