sphincter of Oddi dysfunction
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Epidemiology
- more prevalent among middle-aged women
Pathology
- papillary stenosis
- fixed anatomic narrowing of the sphincter of Oddi, typically due to fibrosis
- sphincter of Oddi dyskinesia
- manometric abnormalities of the sphincter of Oddi
- impedance of pancreatic juice & bile flow
Clinical manifestations
- right upper quadrant abdominal pain
- pain is characteristically sharp, postprandial (1-2 hours), & located in the right upper quadrant or epigastrium
- pain may be associated with nausea &/or vomiting
- pain may last for several hours & can occur at night
- pain may radiate to the back or shoulder blades
- fever, chills, & jaundice are uncommon
- may also present with acute recurrent pancreatitis
Laboratory
- liver function tests may be abnormal*
- serum alkaline phosphatase may be increased
- serum bilirubin may be increased
- serum ALT may be increased
* liver function tests generally normalize between episodes of pain[5]
Diagnostic procedures
- ERCP with sphincter of Oddi mannometry (gold standard)
- upper GI endoscopy with endoscopic ultrasound may be normal[5]
Radiology
- abdominal ultrasound (after fatty meal stimulation)
- biliary scintigraphy
- magnetic resonance cholangiopancreatography* may be normal[5]
- dilated common bile duct in the absence of gallstones[5]
* perform magnetic resonance cholangiopancreatography anyway prior to ERCP despite no stones seen on ultrasound if high risk of cholelithiasis &/or choledocholelithiasis (sickle cell disease)[5]
Complications
- cholecystectomy common due to missed diagnosis
Management
- goal of treatment is to reduce sphincter of Oddi pressure, thereby improving drainage of biliary & pancreatic secretions into the duodenum
- medical, endoscopic, or surgical therapy
- medical therapy:
- calcium channel blockers & long-acting nitrates may reduce basal pressure & improve symptoms
- response rate of only about 75%
- not expected to be effective enough
- endoscopic sphincterotomy is the standard of therapy
- low morbidity and mortality rates
- response rates > 90%
- good results in long-term follow-up
- high complication rate of pancreatitis after endoscopic sphincterotomy
More general terms
Additional terms
References
- ↑ Sphincter of Oddi Dysfunction: Johns Hopkins University http://hopkins-gi.nts.jhu.edu/pages/latin/templates/index.cfm?pg=disease1&disease=12&organ=3&lang_id=1
- ↑ Wikipedia: Sphincter of Oddi dysfunction http://en.wikipedia.org/wiki/Sphincter_of_Oddi_dysfunction
- ↑ Petersen BT An evidence-based review of sphincter of Oddi dysfunction: part I, presentations with 'objective' biliary findings (types I and II). Gastrointest Endosc. 2004 Apr;59(4):525-34 PMID: https://www.ncbi.nlm.nih.gov/pubmed/15044889
- ↑ Sherman S and Lehman GA Sphincter of Oddi Dysfunction: Diagnosis and Treatment JOP. J. Pancreas (Online) 2001; 2(6):382-400 http://www.joplink.net/prev/200111/200111_04.pdf
- ↑ 5.0 5.1 5.2 5.3 5.4 5.5 NEJM Knowledge+ Gastroenterology