Sphincter of Oddi Dysfunction

What is sphincter of Oddi dysfunction?

Sphincter of Oddi dysfunction occurs when a muscle called the sphincter of Oddi doesn’t open when it should to allow the flow of digestive juices. This causes a backup of digestive juices, leading to severe abdominal (belly) pain.

Digestion is a complex process where your body transforms food into energy. Your liver, pancreas and the sphincter of Oddi all play important roles. Your liver produces a chemical called bile that’s stored in your gallbladder. Your pancreas produces enzymes. These digestive juices flow into your small intestine. A muscle called the sphincter of Oddi controls their flow.

When it’s working properly, the sphincter of Oddi opens to allow bile and pancreatic juice to flow through. Then, it closes again. However, with sphincter of Oddi dysfunction, the sphincter muscle doesn’t open as it should. The digestive juices get trapped behind the sphincter of Oddi and cause symptoms similar to what people experience with gallbladder pain.

People who’ve had their gallbladders removed are most likely to develop sphincter of Oddi dysfunction. The procedure to remove the gallbladder is called cholecystectomy, and sphincter of Oddi dysfunction is often called “post-cholecystectomy syndrome.”

Types of sphincter of Oddi dysfunction

There are two basic types of sphincter of Oddi dysfunction:

• Biliary dyskinesia: The digestive juices are unable to drain from your bile ducts into your intestine.
• Pancreatitis: The backup occurs in your pancreas and causes inflammation.

There are also three categories of sphincter of Oddi dysfunction:

• In categories I and II, healthcare providers can find clear evidence of the dysfunction, such as abnormal blood test results or, with an ultrasound, a dilated (widened) bile or pancreatic duct.
• In category III dysfunction, there are no clear-cut lab findings or abnormalities. The only evidence of the dysfunction is the abdominal pain. Type III dysfunction is much more difficult to diagnose and treat.

How common is sphincter of Oddi dysfunction?

Researchers estimate that about 20% of people who experience ongoing pain after gallbladder removal surgery have sphincter of Oddi dysfunction.

Is sphincter of Oddi dysfunction serious?

It’s not life-threatening, and it usually doesn’t cause complications. Still, the pain it causes can interfere with your quality of life. Treatment can provide needed symptom relief that improves your overall health and well-being.

What are the symptoms of sphincter of Oddi dysfunction?

The most common symptom is abdominal pain that’s similar to gallbladder pain. It may feel like a stabbing pain that starts on your upper right side. Sometimes, it radiates to your right shoulder or back. Usually, the pain lasts for 30 minutes to an hour but then resolves until the next symptom flare-up.

The symptoms of sphincter of Oddi dysfunction include:

• Abdominal pain (the most common symptom).
• Nausea & vomiting.
• Fever.
• Chills.
• Diarrhea.

These symptoms can come and go and can be mild one time but severe the next.

What causes sphincter of Oddi dysfunction?

Researchers haven’t identified a single cause. Sphincter of Oddi dysfunction manifests in different ways, which means there may be several contributing factors. Sometimes, sphincter of Oddi dysfunction is related to issues like scarring and inflammation that prevent the free flow of pancreatic juice or bile into your small intestine. Other times, there’s a problem with how the sphincter opens and closes.

Risk factors for sphincter of Oddi dysfunction

You’re more likely to develop sphincter of Oddi dysfunction if you’re a female between 20 to 50 years old who’s recently had gallbladder surgery. Still, several conditions and procedures can increase your risk of developing this condition.

Risk factors include:

• Previous gallbladder surgery (most common).
• Previous gastric bypass surgery (a medical weight loss procedure)
• Recurrent pancreatitis (inflammation in your pancreas).
• Gallbladder agenesis (rare condition where you’re born without a gallbladder).
• Having gallstones (hardened bile clumps in your gallbladder).
• Previous gallstone lithotripsy (a procedure to get rid of gallstones).
• Liver transplant.
• Hypothyroidism.
• Irritable bowel syndrome (IBS).
• Alcohol use disorder (also called alcoholism).
• Taking certain medications, including some opiates.

What are the complications of sphincter of Oddi dysfunction?

Left untreated, sphincter of Oddi dysfunction can lead to:

• Chronic (long-term) pancreatitis: A form of pancreatitis that happens when ongoing inflammation does irreversible damage to your pancreas. Symptoms worsen over time.
• Jaundice: A condition where the skin and the whites of your eyes turn yellow because of high levels of bilirubin in your body. Bilirubin is a component of bile.

How is sphincter of Oddi dysfunction diagnosed?

If your healthcare provider suspects you have sphincter of Oddi dysfunction, they’ll first check to see if another condition is causing your abdominal pain. They’ll rule out peptic ulcer disease or stones in the ducts that carry bile from your liver (choledocholithiasis). It’s important to make sure people with abdominal pain don’t have serious conditions like pancreatic cancer or bile duct cancer.

In some cases, even heart conditions such as angina (chest pain) or ischemia (the heart doesn’t get enough blood) can cause pain that seems to be coming from your abdomen.

What tests will be done to diagnose this condition?

Your healthcare provider will perform blood tests to check for elevated liver and pancreatic enzyme levels. You may need abdominal imaging or scope tests to check for any abnormalities in your sphincter or ducts, including:

• Abdominal ultrasound.
• Computed tomography (CT) scan.
• Endoscopic ultrasound (EUS).
• Upper endoscopy.
• Magnetic resonance cholangiopancreatography (MRCP).
• Nuclear medicine scan of your liver and bile duct.

Some centers perform a test called endoscopic retrograde cholangiopancreatography (ERCP) with manometry. For this test, a healthcare provider places a small plastic tube into the pancreas duct or bile duct near the sphincter of Oddi to measure how well it’s contracting and expanding. Other centers perform ERCP without manometry, but with a plan to perform a sphincterotomy (a type of treatment) in people who likely have sphincter of Oddi dysfunction.

This test isn’t without risk. Up to 30% of people who get this procedure develop pancreatitis. Providers are increasingly using new, less invasive technologies to diagnose sphincter of Oddi dysfunction. These technologies include hepatobiliary scintigraphy. This test can show how digestive fluids flow into your small intestine and at what rates.

Scientists continue to research the safest and most reliable tools to diagnose sphincter of Oddi dysfunction.

How is sphincter of Oddi dysfunction treated?

If the pain isn’t too severe (especially if you have hard-to-diagnose category III disease), your healthcare provider will prescribe non-opioid pain medications or medicines to relieve spasms.

If the pain is severe and you have category I or II disease, your provider may refer you for an ERCP with sphincterotomy. You’ll either be sedated or put to sleep under general anesthesia for this procedure. A surgeon will pass a thin instrument into the area of your small intestine where the sphincter of Oddi is and cut the muscle. The surgeon will also ensure that there aren’t any stones in your bile ducts.

Studies show that sphincterotomy isn’t effective for treating category III sphincter of Oddi dysfunction.

What are the complications of sphincterotomy?

In most cases, sphincterotomy can help relieve the pain and other symptoms of sphincter of Oddi dysfunction in people with category I or II sphincter of Oddi dysfunction. However, your provider will likely try this procedure only if other treatments don’t help.

Sphincterotomy is a complex procedure that has a fairly high risk of complications. About 10% to 15% of patients have complications such as inflammation of the pancreas. This inflammation is usually mild but can be severe and even life-threatening. In some cases, the complications are severe and can require a long stay in the hospital.

What can I expect if I have sphincter of Oddi dysfunction?

Treatment doesn’t completely resolve sphincter of Oddi dysfunction symptoms, but it can provide better pain management and greatly improve your quality of life.

Sphincterotomy improves symptoms in up to 90% of people with category I disease and up to 70% with category II disease. Most people with category III sphincter of Oddi dysfunction get pain relief by taking pain medicines.

What questions should I ask my healthcare provider?

Questions to ask your provider include:

• What caused my condition?
• What tests will I need to diagnose my condition?
• What type of sphincter of Oddi dysfunction do I have?
• What treatments would you recommend?
• What outcomes should I expect from treatment?
• What lifestyle changes can I make to prevent symptom flare-ups?