Sphincter of Oddi dysfunction impairs the flow of bile and pancreatic fluids into the intestines, causing symptoms such as nausea, vomiting, and abdominal pain. It can be caused by physical abnormalities or changes in sphincter function. Diagnosis involves assessing symptoms and taking blood samples and x-rays. Treatment includes anti-inflammatory drugs, a low-fat diet, and surgery if necessary.
Sphincter of Oddi dysfunction is a rare condition that impairs the flow of bile and pancreatic fluids into the intestines. It can cause a number of uncomfortable symptoms, including nausea, vomiting, and sharp abdominal pain after eating. The disorder can occur if the sphincter is too tight or blocked due to inflammation, birth defects, or surgical complications. Doctors may be able to treat minor problems with the sphincter of Oddi with prescribed medications, but surgery is often needed to ensure problems don’t return.
The sphincter of Oddi is a smooth, tubular muscle structure that opens into the duodenum, the upper part of the small intestine. It attaches to the pancreatic duct and common bile duct from the gallbladder. The sphincter contracts and expands to regulate the flow of bile and pancreatic fluid into the duodenum, which helps ensure proper digestion. In the case of sphincter of Oddi dysfunction, fluids back up into the ducts because the sphincter cannot relax and drain.
Most doctors recognize two types of sphincter of Oddi dysfunction. Papillary stenosis refers to physical abnormalities that cause the sphincter to narrow. The most common cause is scarring due to inflammation of the bile or pancreatic duct. Scarring can occur if a person has gallstones or undergoes surgery on the gallbladder, pancreas, or duodenum. Congenital conditions can also affect the size and shape of the sphincter of Oddi.
The second type is called biliary dyskinesia and involves changes in sphincter function. Sudden increases in bile duct pressure or adverse reactions to muscle relaxant hormones can impair the muscle’s ability to pump fluids. The causes of biliary dyskinesia are not well understood, but patients are more likely to develop the condition after having gallbladder removal surgery.
Symptoms may vary depending on the severity of the disorder. Most people notice sharp, shooting pains in the upper abdomen, usually after large meals. A person may also experience frequent bouts of nausea, stomach cramps, vomiting, and loss of appetite. If the condition is left untreated, fluid backup can lead to pancreatitis and gallbladder inflammation. Symptoms tend to become more severe and constant once organs are involved.
Doctors can usually diagnose sphincter of Oddi dysfunction by assessing symptoms, counting liver and pancreatic enzymes in blood samples, and taking abdominal x-rays. If it’s not clear what’s causing the fluid backup, a specialist can use an endoscopic camera to closely inspect the duodenum and sphincter.
Anti-inflammatory drugs and a low-fat diet help some people recover from biliary dyskinesia. If the problem is structural, however, surgery is usually required. A surgeon can implant a stent in the sphincter to keep it open and promote better fluid flow. Occasionally, the entire sphincter must be removed and the ends of the ducts connected directly to the duodenum. Most patients are able to recover from surgery in less than three months and have no recurring problems.
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