to Cyndi

[Guest guest]

Hi Cyndi.

This is T. (there are a couple of 's out there). I was reading

you post about the celic blocks and noticed that you mentioned, I think, that

you were from Ohio. If so, what part. I live in Ohio as well. I live in

Dayton. Are we neighbors?

Let me know, we could visit if we are close.

T.

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[Guest guest]

The sphincter of Oddi is the muscular valve surrounding the exit of the bile

duct and pancreatic duct into the duodenum , at the papilla of Vater. The

sphincter is normally closed, opening only in response to a meal so that

digestive juices can enter the duodenum and mix with the food for digestion.

Sphincter of Oddi dysfunction and papillary stenosis are conditions which occur

when this sphincter (opening) mechanism is disturbed. When the hole is too

tight, there is a backup of bile and pancreatic juices. This can cause pain

(biliary colic). More prolonged obstruction may result in bile leaking back into

the blood stream, resulting in abnormalities of the liver function tests, or

even yellow jaundice (discoloration of the eyes and skin). Also, blockage to the

pancreatic orifice can cause pancreatic pain or attacks of pancreatitis.

Papillary Stenosis can be caused by passage of stones, or scarring after

treatments (e.g. endoscopic or surgical sphincterotomy). Papillary stenosis

usually results in sufficient backup of bile flow that there is stretching

(dilatation) of the bile duct. This can be recognized by scans and various

x-rays, including ERCP. Papillary stenosis requires endoscopic or surgical

treatment. The hole is enlarged by cutting, to improve drainage. Occasionally it

is necessary to do a surgical bypass (choledochoduodenostomy, or Roux-en-Y

hepaticojejunostomy) to insure that drainage is effective.

Spasm of the Sphincter

This is a more difficult problem. It may be one manifestation of other muscular

spasm problems in different areas of the body (such as the esophagus or

intestine--irritable bowel syndrome). However, in some patients, it is the

prevailing complaint, and requires focal attention. The pain symptoms are very

similar to those caused by bile duct or gallbladder stones. Indeed, sphincter of

Oddi dysfunction most frequently occurs in patients who have previously

undergone removal of the gallbladder (cholecystectomy). Some patients present

with unexplained attacks of acute pancreatitis when the pancreatic sphincter is

involved predominantly.

Diagnosis of sphincter of Oddi Dysfunction

Initially, tests are aimed to make sure that there are no stones present.

Standard ultrasound and CT scans are not very accurate in detecting or excluding

bile duct stones; newer techniques such as MRCP and endoscopic ultrasound are

more sensitive, but not yet widely available. Most patients are investigated

with ERCP. The doctor can examine the drainage hole of the bile duct at the

papilla of Vater, and inject dye into the bile duct and pancreatic duct to look

for stones and other forms of obstruction. The possibility of sphincter spasm

(dysfunction) is considered only when these other conditions have been excluded.

Dysfunction can be recognized by a special technique during ERCP, called

sphincter of Oddi manometry (SOM). This involves passing a small catheter (tube)

into the bile duct and pancreatic duct, to measure the squeeze pressure.

Treatment of Sphincter of Oddi Dysfunction

Antispasm medicines are available, but are not very effective. A decision has to

be made whether to cut the sphincter (sphincterotomy), during ERCP, or at

surgery. When sphincter of Oddi manometry has confirmed that the pressures are

high, sphincterotomy gives complete relief in 70-80% of patients; unfortunately,

sphincterotomy also carries a significant risk of complications in this context,

particularly the provocation of pancreatitis , and the possibility of

perforation. Thus, this condition should be approached and managed with

considerable care. Patients may warrant referral to specialist centers.

Sphincterotomy procedures can sometimes scar after months or years, causing

papillary stenosis. Further cutting (repeat sphincterotomy) is sometimes

possible, but there are limits; surgical bypass may be necessary.

Attempts have been made to treat sphincter of Oddi dysfunction without

sphincterotomy-- by placing a temporary plastic splinting tube (stent), or by an

injection of botulinum toxin, which paralyzes the sphincter. These treatments

are experimental.

I hope this finds you and yours well

Mark E. Armstrong

casca@...

www.top5plus5.com

PAI NW Rep

ICQ #59196115

to cyndi

After I got my gallbladder out, I went downhill too. BTW, what's SOD?

Tammy

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