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Sphincter of Oddi dysfunction
1Section on Gastroenterology, Hepatobiliary and Pancreatic Disorders Service, Wake Forest University Baptist Medical Center, Winston-Salem, NC 27157, USA. jbaillie@wfubmc.edu
Current Gastroenterology Reports
|April 29, 2010
Summary
Sphincter of Oddi dysfunction (SOD) is often misdiagnosed. A thorough patient history and physical exam are crucial for identifying the true cause of abdominal pain, rather than relying solely on invasive tests.
Area of Science:
- Gastroenterology
- Abdominal Pain Syndromes
Background:
- Sphincter of Oddi dysfunction (SOD) presents as biliary-type pain, often post-cholecystectomy.
- Many patients referred for SOD lack true biliary sphincter abnormalities.
- Alternative diagnoses include costochondritis, nerve injury, gastroparesis, and visceral hypersensitivity.
Purpose of the Study:
- To highlight the diagnostic challenges in Sphincter of Oddi dysfunction.
- To emphasize the importance of clinical evaluation over invasive testing for abdominal pain.
- To advocate for a multidisciplinary approach in managing pre- and post-cholecystectomy pain.
Main Methods:
- Review of diagnostic criteria and common presentations of SOD.
- Discussion of limitations and risks associated with standard diagnostic work-up (ERCP, manometry).
- Exploration of non-invasive diagnostic modalities (HIDA scans, MRCP).
Main Results:
- Most patients evaluated for SOD do not have a biliary cause for their pain.
- Clinical history and physical examination are often sufficient to identify alternative pain sources.
- Current non-invasive tests for SOD are imperfect and evolving.
Conclusions:
- The diagnosis of Sphincter of Oddi dysfunction is complex and frequently incorrect.
- A comprehensive clinical assessment is paramount in differentiating SOD from other abdominal pain causes.
- A multidisciplinary approach is essential for effective management of post-cholecystectomy pain syndromes.
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