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Sphincter of Oddi dysfunction.

¹Department of Clinical Science, University of Rome, Rome, Italy. enrico.corazziari@uniroma1.it

Digestive and Liver Disease : Official Journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver

|September 17, 2003

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Sphincter of Oddi dysfunction, characterized by stenosis or dyskinesia, causes biliary pain and enzyme changes. Diagnosis involves assessing bile flow and structure, with sphincterotomy as the primary treatment for effective symptom relief.

Area of Science:

Gastroenterology
Hepatology
Surgical Science

Background:

Sphincter of Oddi dysfunction (SOD) presents as biliary-like pain, potentially with elevated liver or pancreatic enzymes.
It encompasses motility disorders like sphincter of Oddi stenosis and dyskinesia, leading to bile and pancreatic juice retention.
Clinical information often focuses on post-cholecystectomy patients, categorized into biliary types I, II, and III.

Purpose of the Study:

To define sphincter of Oddi dysfunction (SOD) and its clinical manifestations.
To review the classification, prevalence, and diagnostic approaches for SOD in post-cholecystectomy patients and those with idiopathic recurrent pancreatitis.
To outline treatment strategies, including sphincterotomy, based on clinical presentation and diagnostic findings.

Main Methods:

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Classification of patients into biliary types I, II, and III based on clinical presentation, lab results, and ERCP findings.
Evaluation of diagnostic work-up including liver biochemistry, pancreatic enzymes, ultrasound, ERCP, EUS, MRCP, and choledochoscintigraphy.
Assessment of sphincter of Oddi manometry and its role in diagnosis and treatment decisions.

Main Results:

SOD prevalence varies significantly across clinical subgroups: 65-95% in biliary type I, 50-63% in type II, and 12-28% in type III.
In idiopathic recurrent pancreatitis, SOD frequency ranges from 39% to 90%.
Sphincterotomy is the standard treatment, with straightforward indications for biliary type I and slow bile transit in type II, while type III may require manometry.

Conclusions:

Sphincter of Oddi dysfunction is a significant cause of biliary pain and pancreatic issues, particularly post-cholecystectomy.
A systematic diagnostic approach, incorporating imaging and functional tests, is crucial for accurate diagnosis.
Tailored treatment, primarily endoscopic sphincterotomy, offers effective management for different types of SOD.