SOD - Sphincter of Oddi Dysfunction
05/12/23 20:40
Have you ever experienced recurrent, unexplained abdominal pain? If so, you might be familiar with the frustrating journey of searching for answers and relief. One potential culprit behind such discomfort is Sphincter of Oddi Dysfunction (SOD). In this blog, we'll delve into what Sphincter of Oddi Dysfunction is, its symptoms, diagnosis, and the available treatments to alleviate this condition.
What is Sphincter of Oddi Dysfunction (SOD)?
The Sphincter of Oddi is a muscular valve located in your small intestine, where the bile duct and pancreatic duct meet. Its primary role is to regulate the flow of digestive juices, specifically bile and pancreatic enzymes, into the small intestine to aid in digestion. SOD occurs when this sphincter doesn't function correctly, causing a range of digestive issues. SOD is most common in patients who have had a their gallbladder removed, especially women.
Symptoms of Sphincter of Oddi Dysfunction:
SOD can present with various symptoms, which can be similar to those of other gastrointestinal conditions. Common signs and symptoms include:
Recurrent Abdominal Pain: The hallmark symptom of SOD is recurrent and often severe abdominal pain, typically in the upper right quadrant or upper middle of the abdomen. This pain often comes on quickly and disappears quickly. Commonly it lasts for several minutes rather than hours or seconds. In between attacks most people are completely free of pain.
Nausea and Vomiting: Patients with SOD may experience episodes of nausea and vomiting, especially after eating fatty foods.
Many people with SOD will also have symptoms of irritable bowel and often functional dyspepsia.
Jaundice: In some cases, when the bile duct is affected, patients may develop jaundice, characterised by yellowing of the skin and eyes.
Diagnosing Sphincter of Oddi Dysfunction:
Diagnosing SOD can be challenging due to its nonspecific symptoms. There is not one test that can be done to prove or disprove the diagnosis of SOD.
Blood Tests: Blood tests can help identify elevated liver enzymes during an attack of pain. Recurrent elevations of LFTs or pancreatic enzymes during pain attacks is highly suggestive of SOD provided gallstones and common bile ducts stones have been excluded.
Imaging: Imaging tests such as MRIs, CT scans, or ultrasound may be used to rule out other conditions and assess the bile duct.
Manometry: Sphincter of Oddi manometry is considered the gold standard for diagnosing SOD. It measures the pressure within the sphincter to determine if it is abnormally high or spasming. This is not a test that is routinely available in Australia.
Treatment Options for Sphincter of Oddi Dysfunction:
The treatment of SOD aims to relieve symptoms and improve the quality of life. The approach may depend on the severity of symptoms and the type of SOD:
Lifestyle Modifications: Dietary changes, such as avoiding fatty foods and eating smaller, more frequent meals, can help manage symptoms.
Medications: In some cases, certain medications can be used and can be highly effective for SOD. These medications are grouped into two types of treatments, those that may help to stop an attack such as Nitrates (GTN spray) or those that may prevent an attack such as the blood pressure tablet Nifedipine or Ursodeoxycholic acid.
Endoscopic Therapy: If a patient has a suspected diagnosis of SOD type I and occasionally type II, endoscopic therapy, such as sphincterotomy (cutting the sphincter) during ERCP, may be recommended to relieve pressure and improve bile and pancreatic duct flow. This is an intervention that carries significant risk of a complication and is only reserved for patients who have failed or are ineligible for medical therapies.
Conclusion:
Sphincter of Oddi Dysfunction is a complex condition that can cause recurrent and debilitating abdominal pain. While it can be challenging to diagnose and treat, a combination of diagnostic procedures, lifestyle modifications, medications, and, in some cases, endoscopic interventions can provide relief and improve your quality of life.
If you suspect you have SOD or are experiencing unexplained abdominal pain, it's crucial to seek medical advice. A gastroenterologist can help evaluate your symptoms, conduct appropriate tests, and create a personalised treatment plan to address your specific needs. Remember that early diagnosis and proper management can significantly improve your overall well-being and relieve the discomfort associated with SOD.
What is Sphincter of Oddi Dysfunction (SOD)?
The Sphincter of Oddi is a muscular valve located in your small intestine, where the bile duct and pancreatic duct meet. Its primary role is to regulate the flow of digestive juices, specifically bile and pancreatic enzymes, into the small intestine to aid in digestion. SOD occurs when this sphincter doesn't function correctly, causing a range of digestive issues. SOD is most common in patients who have had a their gallbladder removed, especially women.
Symptoms of Sphincter of Oddi Dysfunction:
SOD can present with various symptoms, which can be similar to those of other gastrointestinal conditions. Common signs and symptoms include:
Recurrent Abdominal Pain: The hallmark symptom of SOD is recurrent and often severe abdominal pain, typically in the upper right quadrant or upper middle of the abdomen. This pain often comes on quickly and disappears quickly. Commonly it lasts for several minutes rather than hours or seconds. In between attacks most people are completely free of pain.
Nausea and Vomiting: Patients with SOD may experience episodes of nausea and vomiting, especially after eating fatty foods.
Many people with SOD will also have symptoms of irritable bowel and often functional dyspepsia.
Jaundice: In some cases, when the bile duct is affected, patients may develop jaundice, characterised by yellowing of the skin and eyes.
Diagnosing Sphincter of Oddi Dysfunction:
Diagnosing SOD can be challenging due to its nonspecific symptoms. There is not one test that can be done to prove or disprove the diagnosis of SOD.
Blood Tests: Blood tests can help identify elevated liver enzymes during an attack of pain. Recurrent elevations of LFTs or pancreatic enzymes during pain attacks is highly suggestive of SOD provided gallstones and common bile ducts stones have been excluded.
Imaging: Imaging tests such as MRIs, CT scans, or ultrasound may be used to rule out other conditions and assess the bile duct.
Manometry: Sphincter of Oddi manometry is considered the gold standard for diagnosing SOD. It measures the pressure within the sphincter to determine if it is abnormally high or spasming. This is not a test that is routinely available in Australia.
Treatment Options for Sphincter of Oddi Dysfunction:
The treatment of SOD aims to relieve symptoms and improve the quality of life. The approach may depend on the severity of symptoms and the type of SOD:
Lifestyle Modifications: Dietary changes, such as avoiding fatty foods and eating smaller, more frequent meals, can help manage symptoms.
Medications: In some cases, certain medications can be used and can be highly effective for SOD. These medications are grouped into two types of treatments, those that may help to stop an attack such as Nitrates (GTN spray) or those that may prevent an attack such as the blood pressure tablet Nifedipine or Ursodeoxycholic acid.
Endoscopic Therapy: If a patient has a suspected diagnosis of SOD type I and occasionally type II, endoscopic therapy, such as sphincterotomy (cutting the sphincter) during ERCP, may be recommended to relieve pressure and improve bile and pancreatic duct flow. This is an intervention that carries significant risk of a complication and is only reserved for patients who have failed or are ineligible for medical therapies.
Conclusion:
Sphincter of Oddi Dysfunction is a complex condition that can cause recurrent and debilitating abdominal pain. While it can be challenging to diagnose and treat, a combination of diagnostic procedures, lifestyle modifications, medications, and, in some cases, endoscopic interventions can provide relief and improve your quality of life.
If you suspect you have SOD or are experiencing unexplained abdominal pain, it's crucial to seek medical advice. A gastroenterologist can help evaluate your symptoms, conduct appropriate tests, and create a personalised treatment plan to address your specific needs. Remember that early diagnosis and proper management can significantly improve your overall well-being and relieve the discomfort associated with SOD.