Type 3 Sphincter of Oddi

[telaine]

I had my gallbladder removed the summer of 2006 and a month  later started having nausea and pain just under my ribs on the right side.  After months of tests with the local doctor and no findings I started seeing a gastroenterologist in a larger city.  He found that I am not digesting fat well.  He thinks the nausea and pain is being caused by the sphincter of oddi and I am to meet with him the end of this month to talk about what to do.  

I am a 50 yr old female.  I have been sick everyday for almost a year and a half.  I wake in the morning sick to my stomach.  Most days it goes away after drinking a couple of glasses of diet coke.  On days that it doesn't go away I take phenergan.  I don't eat until noon becuase that way I stay well enough to get some things done.  Anywhere from an hour to three hours after I eat I start getting nauseaous again.  by evening the phenergan doesn't help it much so I take a med to help me sleep and go to bed.  I wake in the night sick to my stomach.  It goes away with either a couple of diet cokes or phenergan.  

If I eat very little fat the nausea isn't as bad and the pain and diarrhea isn't as bad.  My bed is elevated  becuase over the last year I have developed reflux and I am on prilosec and zantac.  Every time after I eat I have mucous that comes up my throat and I have to spit it out.  It only happens after I eat and when I first get up.  I don't have a cough.

Every part of my body has been tested and I am fine except this nausea, diarrhea, and pain in my right side.  The doctor says the diarrhea is from not digesting fat.  

1)Do my symptoms sound like sphincter of oddi?

2)The doctor said it may be type three.  Is there any help for this type three?

3)Is this damaging my liver since it has been going on for over a year?

Any help you can give me would be appreciated.  I don't even know what to ask the doctor when I see him.
Thank you.

[Kevin Pho, MD]

You have clearly had a comprehensive evaluation, and it would be unlikely that I can come up with something over the internet that hasn't already been thought of.

1) Sphincter of Oddi dysfunction can certainly be considered.  An ERCP along with Sphincter of Oddi manometry is the test of choice if this is suspected.

2) Conservative therapy can be considered with calcium channel blockers or nitrates.  If the symptoms continue, more invasive options like injection of Botulinum toxin or surgical procedures like a sphincterotomy can be discussed.  

3) If there is concern about the liver, obtaining liver function tests can be considered.  Imaging with an ultrasound can also detect possible liver damage.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patients education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
www.kevinmd.com

[telaine]

I forgot to say that I've had a gastric emptying test, several ct scans and exrays with dye on my intestines and pancreas, gobs of blood tests, a brain scan, lungs exrayed, tests for autoimmune disease and on and on.  I am perfectly healthy other than daily nausea, diarrhea and pain in the right side.  The pain isn't the kind that doubles me over,,, I just feel it after eating and when I go to bed.  The only abnormal findings are the trouble digesting fat and the erosion in my esophagus.  Last December my liver enzymes were high but were normal last time they checked in April.  
Could this just be really bad acid reflux?  The nausea gets worse once I stand up in the morning then gets better with diet coke and phenergan.
Thank you for your help.

[snoopy504]

I was recently diagnosed with sod type III.  I had a sphincterotomy with stent placement 3 weeks ago.  I had pain for about 7 days after the procedure and then started to feel great.  I was finally able to eat again without feeling sick.   However that did not last long- my symptoms are starting to return.  My local GI doctor says I need to give  it at least one more month.. I was informed prior to the procedure- that I had a 50/50 chance that it would help.  I do not regret having the procedure done.  I just wish I would get better.  I am tired of be sick. I understand how fustrating this is for you. I hope you feel better soon

[supermom143]

I would love to talk to you about your procedure. I have a 14yo with SOD and not sure what to do. Do you have an email adddress?

[lucy808]

I have a very similar story.  I avoid caffeine and alcohol and most fatty foods.  I go through spells of nausea, diarrhea and abdominal discomfort.  I have had the million dollar work-up which has been negative.  I wish I could pinpoint what makes this worse - but have had no luck yet! It is exhausting.   I have no advice to give but perhaps knowing there are other people like you is comforting.  Good luck!

[diane304]

I have also been experiencing problems with severe nausea, vomiting and pain.  I have been having this for 10 - 15 yrs at least.  It seems to have started after I had my gallbladder removed 27 yrs ago.  My gastro doctor just notified me today that I need to have my liver function tests repeated because my alkaline phosphate and my ast are evalvated.  I have had numerous test done and was in the hospital at the end of October for 6 days.  I have went to UVA in Charlottesville, VA and the doctor there thinks that it may be problems with the sphincter of oddi, my regular gastro doctor doesn't want to do surgery for this because he doesn't feel the symptoms warrant it yet.  I have had the gastric emptying study done and that came back positive.  I know that it can be be fustrating Telaine, to do through all of the tests and the symptoms can get overwhelming.  My advice is to keep looking for answers yourself and suggestions that you can make to your doctor, I feel that 2 heads are always better than 1 and anything you can suggest to your doctor is worth a shot.  If you doctor can't handle your suggestions, I would definitly look for another doc.  Doctors are only human and sometimes they need advice to.  Good luck and let us hear how things are going.