Sphincter of Oddi: Function, dysfunction, and its management

Abstract

The most common functional disorder of the biliary tract and pancreas relates to the activity of the Sphincter of Oddi. The Sphincter of Oddi is a small smooth muscle sphincter strategically placed at the junction of the bile duct, pancreatic duct, and duodenum. The sphincter controls flow of bile and pancreatic juices into the duodenum and prevents reflux of duodenal content into the ducts. Disorder in its motility is called Sphincter of Oddi dysfunction. Clinically this presents either with recurrent abdominal biliary type pain or episodes of recurrent pancreatitis. Manometry may identify the motility abnormalities, the most clinically significant being an abnormally elevated basal pressure. The most effective treatment once an abnormal basal pressure is identified is division of the sphincter. This is associated with good long-term results.

The postcholecystectomy syndrome: a review of etiology and current approaches to management

“…This classification is useful in identifying the subset of patients with Type I SOD, who have a greater than 90% chance of symptomatic improvement from EBS regardless of the results of manometry (Table 2). [20][21][22][23][24] This consistent response suggests that the underlying pathophysiology of Type I SOD may be SO stenosis; however, no studies have proven this association. It is now common practice to bypass SOM and proceed straight to EBS in this subset of patients.…”

Surgical treatments for patients with recurrent bile duct stones and Oddis sphincter laxity

“…The sphincter of Oddi relaxes while gallbladder contracts, the bile is discharged into the duodenum (34,35). Neural and hormonal regulation of Sphincter of Oddi loses work when there is Oddis sphincter laxity, the basal pressue of biliary tract decreases, then resulting in gallbladder excessive filling and possible decreased discharge of bile flow into duodenum, and subsequently biliary tract cholestasis develops.…”

Hypertriglyceride Induced Acute Pancreatitis

“…Adequate pain control is essential, often through the use of opioid narcotics [88][89][90] . Some controversy still remains about the potential for medication-induced sphincter of Oddi dysfunction aggravating the clinical picture although low dose transdermal fentanyl patches appear do not to compromise sphincteric function 91,92 . Meperidine has been used as an alternative analgesic to treat pain in those suffering from acute pancreatitis, but concern for the production of toxic metabolites has altered prescribing practices [93][94][95] .…”