Sphincter of Oddi Dysfunction

Digestion of the food we eat into the energy we need is a complex process that involves glands, chemicals and muscles like the liver, the pancreas, and the sphincter of Oddi to play important roles.

A sphincter is any muscle in your body that controls an opening and closing. When it’s working properly, the sphincter of Oddi controls the flow of bile and pancreatic juice from the pancreas into the small intestine and prevents bowel contents from backing up into the pancreatic and bile ducts.

In a disorder called sphincter of Oddi dysfunction, the sphincter muscle does not open when it should. This prevents the bile and pancreatic juice from flowing through and causes a backup of digestive juices. The backup can cause bouts of severe pain in the abdomen.

Virginia Mason gastroenterologists within the Digestive Disease Institute treat this problem. For more information or to schedule an appointment, call (206) 223-2319.

Symptoms of Sphincter of Oddi Dysfunction

The most common symptom of sphincter of Oddi dysfunction is abdominal pain. Less common symptoms include:

  • Nausea
  • Vomiting
  • Fever
  • Chills
  • Diarrhea

Symptoms can vary and can be mild one time and severe the next.

Diagnosing Sphincter of Oddi Dysfunction

When sphincter of Oddi dysfunction is suspected, your doctor will first check to see if the abdominal pain is caused by another condition.

Your doctor may want to take a close look at the sphincter of Oddi to see if it is functioning normally. This procedure is called sphincter of Oddi manometry and involves the patient being placed under sedation while the doctor places a small plastic tube into the pancreas duct or bile duct near the sphincter of Oddi to measure how well it is contracting and expanding.

There are three categories of sphincter of Oddi dysfunction.

  • Categories I and II: Doctors can find clear evidence of the dysfunction, such as abnormal blood test results or a dilated bile duct, which might be found by using an ultrasound test.
     
  • Category III dysfunction:There are no clear-cut lab findings or abnormalities, and the only evidence of the dysfunction is abdominal pain. The pain is believed to be caused by a sudden spasm of the sphincter of Oddi. Category III dysfunction is much more difficult for doctors to diagnose and because the pain is typically multi-factorial, it can only be treated medically.

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Treating Sphincter of Oddi Dysfunction

The goal of treating sphincter of Oddi dysfunction is to reduce pressure on the sphincter, which reduces your pain and will improve drainage of the biliary and pancreatic juices into the small intestine.

Depending on the type of condition you have and how severe your symptoms are, the following treatment options may be considered:

  • Medication:Treating sphincter of Oddi dysfunction with medication is the preferred method because it is non-invasive and avoids the possible severe complications of surgery. The sphincter of Oddi is made of smooth muscle, and medications that relax smooth muscle may be an effective treatment option. Other medications aim to reduce sphincter pressure and reduce symptoms. Drawbacks of medication include side effects and that certain types of the condition may not respond to medication.
     
  • Surgery:A common procedure performed for sphincter of Oddi dysfunction is a transduodenal sphincteroplasty. A sphincteroplasty is a reconstruction of your sphincter muscle. In this case your surgeon accesses your sphincter of Oddi through your duodenum (small intestine).
     
  • Endoscopic Therapy:The standard of therapy for sphincter of Oddi dysfunction is endoscopic sphincterotomy. Your doctor uses an endoscope to locate the sphincter of Oddi and then cuts the muscle to prevent future spasms. After endoscopic sphincterotomy, there is a risk of developing pancreatitis, so a short-term stent is placed to keep the sphincter open.

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