Sphincter of Oddi Function and Dysfunction

Toouli, James; Craig, Alexander

doi:10.1155/2000/313601

Cited by 17 publications

(17 citation statements)

References 85 publications

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“…However, its action is short lived and it cannot be taken prophylactically. The calcium channel blocker nifedipine has also been used with some success in relieving pain, but it may be associated with cardiovascular side effects (16,17). …”

Section: Summary For Treatment Of Sphincter Of Oddi Dysfunctionmentioning

confidence: 99%

Biliary dyskinesia

Toouli

2002

Curr Treat Options Gastro

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Biliary dyskinesia is a motility disorder that affects the gallbladder and sphincter of Oddi. The motility disorder of the gallbladder is called gallbladder dyskinesia. Patients with this condition present with biliary-type pain, and investigations show no evidence of gallstones in the gallbladder. The diagnosis is made by performing a gallbladder ejection fraction, which is a radionuclide investigation. An abnormal gallbladder ejection fraction has a value less than 40%. Patients with an abnormal gallbladder ejection fraction should undergo cholecystectomy. This procedure has been shown to be effective in curing the symptoms in over 90% of patients. Motility disorder of the sphincter of Oddi is called sphincter of Oddi dysfunction. This disorder is categorized as two distinct types--biliary sphincter of Oddi dysfunction and pancreatic sphincter of Oddi dysfunction. Typically, patients with biliary sphincter of Oddi dysfunction present with biliary-type pain on average 4 to 5 years after having undergone cholecystectomy. Sphincter of Oddi manometry is essential in making a diagnosis of abnormal motility of the sphincter. On manometry, diagnosis of a sphincter of Oddi stenosis should lead to division of the sphincter. Sphincterotomy results in long-term relief of symptoms in more than 80% of patients. Pancreatic sphincter of Oddi dysfunction clinically presents with recurrent episodes of pancreatitis of unknown cause. Having ruled out all of the common causes of pancreatitis, sphincter of Oddi manometry of the pancreatic duct sphincter should be performed. When manometric stenosis is diagnosed, these patients should undergo division of both the biliary and pancreatic duct sphincter. This treatment results in relief of symptoms in more than 80% of patients.

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Section: Summary For Treatment Of Sphincter Of Oddi Dysfunctionmentioning

confidence: 99%

Biliary dyskinesia

Toouli

2002

Curr Treat Options Gastro

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“…Most studies emphasize the musculature (so-called sphincter Oddi) of the greater duodenal papilla (papilla Vateri) [9,11,16] or the oblique passage through the duodenal wall [14] as the most important mechanisms. The ring-like muscular fibers that form the sphincter of Oddi have been accorded the most important role in the closure system of the papilla Vateri [3,11].…”

Section: Discussionmentioning

confidence: 99%

Functional anatomy of the papilla Vateri

et al. 2001

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Mucosal folds form pocket-like valves in the lumen of the ampulla Vateri. They allow a unidirectional flow of secretions into the duodenum and prevent reflux from the duodenum into the ampulla Vateri. Subepithelial mucous gland secretions functionally clean the valvular crypts and protect the epithelium. The arrangement of pocket-like mucosal folds may explain endoscopic difficulties experienced when attempting to penetrate the papilla of Vater during endoscopic retrograde cholangiopancreaticographic procedures.

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“…Patients underwent endoscopic SO manometry with a standard triple-lumen catheter (Wilson-Cook, WinstonSalem, NC) with each lumen perfused at 0.13 mL/min, as has been previously described [21]. The assembly was withdrawn through the SO of the biliary duct.…”

Section: Manometrymentioning

confidence: 99%

Biliary scintigraphy versus sphincter of Oddi manometry in patients with post-cholecystectomy pain: Is it time to disregard the scan?

Toouli

2005

Curr Gastroenterol Rep

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Sphincter of Oddi (SO) dysfunction is diagnosed using manometry, and patients with an abnormal SO basal pressure respond well to division of the SO. However, manometry is invasive and is associated with a low, yet significant, incidence of complications. Scintigraphy techniques have been developed with the aim of providing a noninvasive means of assessing SO motility. However, when compared with SO manometry these techniques fall short in sensitivity and specificity for diagnosing SO dysfunction. Furthermore, they do not select patients who will respond to treatment. Consequently, the quest for development of a noninvasive investigation for diagnosis of SO dysfunction continues. In the mean time, improved manometric techniques that enhance reproducibility and reduce complications have been developed.

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Sphincter of Oddi Function and Dysfunction

Cited by 17 publications

References 85 publications

Biliary dyskinesia

Biliary dyskinesia

Functional anatomy of the papilla Vateri

Biliary scintigraphy versus sphincter of Oddi manometry in patients with post-cholecystectomy pain: Is it time to disregard the scan?

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