What is sphincter of oddi dysfunction and the symptoms?

[Karen]

What is sphincter of oddi dysfunction and the symptoms?  My current condition:  for over a year now, have pain in urq radiating to mid-right back and right shoulder blade.  Constant pain.  Worse after eating.  After eating, feels like something tied around my back and chest real tight and won't let up.  Sometimes pain in back and shoulder is dull, sometimes sharp.  In october, went to dr because of running fever and vomiting.  Found blood in my urine and diagnosed me with kidney infection even though didn't have signs like burning sensation when urinating.  Have had all tests done:  barium enema, upper gi tests, hida-scan, other tests for gallbladder and liver.  All blood tests are normal.  While taking Cipro (antibiotic) for so-called kidney infection and a bad sore throat another time, this seemed to keep my pain down to a minimum, but as soon as I finished taking it, the pain would start at full speed again and get worse.  Could this be a case of sphincter of oddi dysfunction?  Should I go see a gastroenterologist?  Does anyone else have this type of symptoms?
Thank you, Karen

[HFHSm.D.-Gastro-rf]

Dear Karen,
Sphincter of Oddi dysfunction is a condition in which the sphincter (located at the jumction of bile duct and duodenum) fails to relax appropriately.  The common bile duct may become distended with bile and pancreatic secretions necessary for digestion.  The symptoms of sphincter of Oddi dysfunction are epigastric and right upper quadrant pain that can mimic the pain seen with gall bladder disease.

If you have persistent symtoms of abdominal pain and a diagnosis has not been made despite an appropriate series of tests, then you should consider seeing a gastroenterologist.  ERCP, a test in which dye is injected into the bile duct, can suggest sphincter of Oddi dysmotility.  (Delayed emptying of the dye is noted in patients with sphincter dysfunction.)  Measurement of the sphincter pressures are often performed to confirm the diagnosis.  Cutting the sphincter via a special catheter passed through the endoscope often relieves the abdominal pain.

[Karen]

forgot to add that I have been taking Propulsid because of acid reflux as well.  Have been taking that and previously have been on prevacid and prilosec.  thought i had an ulcer, but have been on antacids and strict diets for too long for it to be something of that sort.
karen

[bill]

Karen: I had similar symptoms (but no blood). I had some knowledge abt the symptoms of GERD & Barrett's Esophagus. The pains I had (shoulder (front and back), under my arm, under the sternum, and across back was GERD pain. I furst went to a heart specialist for tests. They were negative. Then, I went to a Gastroenterologist and confirmed i have Barrett's Esophagus. Yes, I would go to a Gastroentologist. When they did the tests on you, did they do the endoscopy (tube/scope through mouth, esophagus and stomach) to see the condition of the linings of your stomach/esophagus? This is how they diagnose GERD (reflux disease) and Barrett's Esophagus.

[bill]

Karen: I had similar symptoms (but no blood). I had some knowledge abt the symptoms of GERD & Barrett's Esophagus. The pains I had (shoulder (front and back), under my arm, under the sternum, and across back was GERD pain. I furst went to a heart specialist for tests. They were negative. Then, I went to a Gastroenterologist and confirmed i have Barrett's Esophagus. Yes, I would go to a Gastroentologist. When they did the tests on you, did they do the endoscopy (tube/scope through mouth, esophagus and stomach) to see the condition of the linings of your stomach/esophagus? This is how they diagnose GERD (reflux disease) and Barrett's Esophagus.

[Karen]

no, i haven't had that done since 1996 when I was diagnosed with the H. Pylori bacteria.  I know what Barrett's Esophagus is.  Is it cureable if that catch it in time?  If so, what do they do?  How are you doing with it?
Thanks for the information.
Karen

[wendell]

Karen, it sounds as though your system is far too acidic. I have an excellent book on nutritional healing and suggest you could likely benefit from quality digestive enzymes and acidophilus.

This book recommends natural supplements, not drugs, and I have seen them help lots of people.

If you'd like to e-mail me directly, I may be able to offer some specific herbal recommendations from this book.

Regards,

Wendell      < ***@**** >

[Karen]

Wendell,  thank you for your response.  I have tried the alternative herbal remedies such as bromelain and acidophilus.  the pain was still very bad.  I would love nothing more than to get off of these drugs.  I am a health nut and can't stand it!  If you have any other suggestions, I would love to hear from you.
Thank you, Karen

[bill]

I forgot to tell ya'll that I have an appointment next Wednesday to go to the Gastroenterology Clinic at Baylor Hospital, Dallas. Maybe they can give me some beter information/results than I've been receiving. At least, I will have more confidence in the quality of treatment.

[Heather H.]

At 19 years old, Two drugs were prescribed to treat the Sphincter of Oddi spasms I was having: Calan SR (which I took daily for 3 years and did not continue to have any more 'attacks'), and also Nitrostat (nitroglycerin under the tongue for if I had an emergency attack). The Calan relaxed the sphincter muscle, preventing any more strictures or spasms.
Before a new, good MD came to this conclusion (I had seen several docters before this last one), I had suffered terrible pain in my upper abdomen, in the middle and slightly to the right side, and some what in my back, accompanied by hot flashes, sweating, and eventuallly, but not always, vomiting.  Also white colored bowel movements could happen the day after an attack.  
  After many tests(x-ray, ultrasounds, CAT scan, ERCP which caused pancreatitis, etc.,..) I was told I should have surgery to cut the sphinter muscle.  I looked for another opinion, and was told an alternative treatment could be done with Calan SR, and Nitrostat.  This helped greatly.  However, I decided to go off the Calan because I was getting married and wanted to conceive, but continued with the Nitrostat in case I had an emergency.
   I hope this can help someone reconsider having to be cut for surgery.

[Deanna]

Hi -  I have dealt with Sphincter of Oddi disorder for many years.  I am 36 years old now and I had symptoms off and on for about ten years before the condition was correctly diagnosed.  About 8 years ago I underwent an ERCP where they cut the sphincter muscle and I haven't had any problems since.  Until about a week ago when my 10 year-old daughter experienced the same extreme pain and vomitting.  It took many trips to the ER and GI doctor before they diagnosed her with the same condition.  I couldn't believe it!  Have any of you heard of this condition being heriditary??  Her condition is improving now and her doctor is going to wait to perform the ERCP until she has another attack.  The doctor mentioned that there are increased risks to a child undergoing an ERCP.  Any information would be most helpful.  Thanks!

[Suzanne]

hi

well I have had SOD since june of last year possibly longer,
my main problrm is that I did not display the classic signs of SOD being that during this whole time my liver function tests continue to be normal.
I have had extreme pain in the upper right quadrant, with no known triggers, food stress sex etc.
I have not experienced neausea,other than that associated with the narcotics.
I have had every concevable test, to see if it was something else.
i have had two spincterotimies, these were three years ago. my problem is that my duct has narrowed  

In the next 2 weeks I am to see a surgeon for invasive surgery  to have my bile duct cut and restitched, this i hapoe will solve the problem and get my off the drugs.

My casr was refered to  a proffessor in Sydny who specialises in SOD and one of the questions he asked was do I have bad circulation, we i have very bad circulation, what I'd like to know do the  rest of you suffer from bad circulation?

thanks

Suzanne

[GEORGIE]

To Suzanne:
Hi, I think we have spoken before. Suzanne just
a few questions. After the 2 sphincter procedures
that you have had, did the pain diminish at all
afterward, even for some time?  Also w/ the bad
circulation, I find my hands go numb alot quicker
now and sometimes even when I'm not (sleeping on
them) Is this a sign of poor circulation? I read
somewhere, but can not recall where, that narcotics
can make SOD worse or even trigger it. I have been
taking synthetic oppiate painkillers for an un-related
problem, 6 months later is when my symptoms began:
Dull pain in URQ, always there sometimes more severe
than other times w/ no apparant triggers!
Although ultrasound has found stones my syptoms (symptoms) ARE
NOT CLASSIC of gallstone attack. MY liver functions
(enzymes) are all normal. Cholesterol is high, is
yours?
What kind of test did you go for? What do you recomend
Thanx in advance........***@****

[Loretta Lyons]

02/07/98 I had a CTS done on my abdomen I was told that I had a thickening of the second portion of the duodenum which is circumferential. Could you plase tell me what this is. I have so much pain in my right side and in my back.

[Jerry W. Cook]

I have recently discovered that my liver is overproducing certain enzymes above normal.  Then one night I had severe pains in the abd area and spent a night in the hospital.  I have made an appointment with a gastroenterologists but have not seen one yet.  I also have a lot of burping(no odor) and "ghost" bowel movements.  Any suggestions as to what I should do next?

[Sandy Imblum]

I had episodes of upper right quadrant pain usually after eating too much of a good thing.  I had gone to one gastro doctor who ran 3 tests.  The first was a sonogram in October which was negative.  Then a hyda scan was done in November for the gallbladder, also negative.  This did, however, indicate concerns about my liver and also caused the same pain, so they did a catscan which was negative.  My gallbladder was functioning at 80%.  That doctor's nurse said to go back to my primary physician.  I went back to the primary physician who was just as frustrated as I was.  The gastrologist had not even done a colonoscopy which I was overdue, nor had he bothered to discuss the test results.  I was beginning to think I was crazy and stress was causing it all.  My Mother had passed away in October from cancer of the pancreas, gallbladder, liver, etc. so of course I was scared also.  But I was determined to find out the cause of my pain and eliminate it.  I had just retired from working and  wanted to get on with the "good life".

She referred me to another doctor that I had heard about while sitting in a waiting room for my catscan.  Another patient had raved about him.  I took the person's recommendation and went to the new gastrologist.  He impressed me as a very concerned doctor who followed through with all of his patients.  He saw me on a Thursday and on the next Monday he did a colonoscopy.  Then on Wednesday he did an ECRP to look at everything especially the opening of my bile duct. He suspected my sphincter of oddi was malformed. He injected dye and then performed a procedure called endoscopic sphincterotomy.  The next couple of weeks were quite painful, but I didn't bother the doctor.  I was allergic to the pain medication, so I just suffered.  At 2 weeks I called to check in and he yelled at me because I had used some Advil (4 every 6 hrs.)in desperation.  He said I could have bled badly because it worked just like asprin.  He also said I probably had developed pancreatitis and that was causing the pain.  

The pain has subsided and it has been 5 weeks now.  I put myself on a really low fat diet as I have been gaining weight the past few months and my cholesterol is just under 300.  I am on Lipitor for that.  The pain still persists however, if I eat anything fatty.   All of my tests came back negative for gallstones, so where do I go from here?  I am planning to travel and sure don't want to end up in an emergency room with pain.  The doctor told me that if the pain returned he would send me to a surgeon to take out my gallbladder or at least re-evaluate the situation.  I just don't want to go through more surgery?  Any other options out there?  The pain isn't sharp, just a constant dull ache which gets worse if I eat something.

[Cyndie]

Hi. 4 yrs. ago I also was diagnosed with Sphincter of Oddi dysfunction. A sphincterotomy was performed and I was discharged 1 month later and went home with a central line and Hyperal.I have since had several dilatations of the common bile duct, frequent attacks of Pancreatitis and am still experiencing the same symptoms and pain as I originally had!I now suffer from Chronic Pancreatitis (and I mean suffer!) I take several narcotics for pain, Sandustatin inj. for Pancreatic spasms, and enzymes. However, I was told by my Specialist that there is nothing else that can be done.I am very frustrated! I do not intend to live the rest of my life like this!Please, if there's anyone out there that might have any ideas, I'd certainly welcome them! (And yes, I am taking an antidepressant!)Thanks.

[Suzanne]

TO GEORGIE

HI
sorry I have not responded to you before this but I admited myself to Hospital 3 weeks ago with extreme pain, and the result is a 20cm gash in my belly.

to answer your questions
1)yes one of the possible side effects of all the narcotics is the possible tightening of the sphinter, but to put this in to context,another possible side effect is also uncontrolable muscle spasms in the face. The relief out ways the risk for me personally, and I have to say that there was for me no real increase in the duration nor the severity of the pain while I was on the narcotics.
2) Bad circulation for me is that if I get cold then my extremities turn white then blue. this is to the extreme of me walking in to an airconditioned area, I will get cold,I live in a warm area of Eastern Australia and I spend winter in thermal underware, and summer in cardigans.
90% of the time my hands and feet are cold.

3) I had a period of 3 years where I was totally pain free. Then in june of last year all Hell broke loose, the end result being my Sphintrplasty (I think that is how it is spelt)2 weeks ago.
I have had Cat Scans,utrasounds,gastophy, colonosphy (again not sure on the spelling)ECRP's,a billiary memnometry (again unsure as to the spelling) and finally the operation 2weeks ago.

It seems funny to me that in the States as I assume most of you are from you have real problems with getting  this diagnosis.
It was found in my case that my sphinter had in fact shrunk to the size of a pin head and that this was causing my pain.
I wont know for at least 5weeks if this has been successful as that was the longest I have ever been with out a serious attack.
I am hopeful

[Mary Kay]

I have had SOD for at least 6 years now, ocurring several years after a Cholecystectomy.   I have had 5 ERCP's with Sphincterotomies and several sphincter dilitations.   Only last 4-6 mos.   Can't take Nitroglyerin because the vasodilitation precipitates my life long Classic Migraine Headache problems....... When I get the Migraines I can't take the Midrin perscribed for the headache because it precipitates Sphincter of Oddi spasms...... I have competing illnesses!   I too have recently experienced the shoulder, under the arm and shoulder blade (or scapula)pain, a new addition to the rountine, long term upper Right abdominal quadrant pain.    My PCP has just started me on Questran (Cholestyramine, the chloride salt of a basic anion exchange resin and a cholesterol lowering agent,) often given  to pts with elevated Chol. levels and pts with vascular disease ....and cardiovascular disease.  In my case, it seems to be helpful in cases of partial biliary obstruction.   Will keep you updated ....... when I get an "attack"  I also become very bloated, with diarrhea , terrible abd cramping and of course, the white stools, on top of the severe pain.... I always feel like a limp dishrag when the episode is completed and have had to take more than my fair share of time off at work.......does anyone else have these GI symptoms as well?  PS: my cholesterol levels are normal (123) as well as my HDL and LDL levels....

[jennifer]

I am an overweight 17 year old female.  I experience pains in both sides of my lower abdomen, that feel like sharp twinges that eventually go away, but are still bothersome.  I am afraid something is wrong with me but i'm too afraid to go to the doctor because i'm afraid it might be something serious.  The pains happen between menstrual cycles, so I don't know if it has anything to do with that or not.  I also get pains above my breasts, which i'm not sure is serious or not either.  Please help..

[Suzette Levy]

After reading all of these posts I am wondering if any of you have been tested for automatic nervous system problems . My enteric nervous system (gut) does not work properly as I have motility problems, RUQ pain, SOD attacks, and Orthostatic Intolerance or dysautonomia. My GI physician here in Florida sent me to Blair Grubb, M.D. in Ohio at the Medical College of Ohio where I was properly diagnosed. I have many other symptoms either diarrhea, or constipation, bloating, gas, etc, Don't want to bore you with details, however just wondered if any of your GI physicians thought you might have this??? You can email me at ***@****

[sabira merchant]

i have had SOD following the removal of my gall bladder.. had two ERCPs, during the last one i also had a sphincteroctomy but after two months the attack of pain came back with a bang.. this followed a fairly heavy meal.. the docs want me to have another ERCP  and feel that a stent will help keep the bile duct open which goes into spasm at will.. has anybody withSOD had a stent inserted... did it help... i live in india and will have to travel to the usa for treatment which is supposed to be great in north carolina where there is a special cell set up for people suffering.. the attacks when they are there are extremely painful with elevated liver function tests which go to normal very quickly .... any comments and info would be most helpful.. thanks....

[sabira merchant]

i have had SOD following the removal of my gall bladder.. had two ERCPs, during the last one i also had a sphincteroctomy but after two months the attack of pain came back with a bang.. this followed a fairly heavy meal.. the docs want me to have another ERCP  and feel that a stent will help keep the bile duct open which goes into spasm at will.. has anybody withSOD had a stent inserted... did it help... i live in india and will have to travel to the usa for treatment which is supposed to be great in north carolina where there is a special cell set up for people suffering.. the attacks when they are there are extremely painful with elevated liver function tests which go to normal very quickly .... any comments and info would be most helpful.. thanks....

[Susan]

Hello everyone,

I have been reading replies about "Sphincter of Oddi Dysfunction".  The reason being is that I was trying to get a handle on what was wrong with me?

I have a constant pain on my right side of my stomach and it will not go away.  Changing my eating habits did help a little.  I eat very few carbohydrates which lessened the pain.

Because Sphincter of Oddi dysfunction is a condition in which the sphincter fails to relax appropriately I was wondering because I have fibromyalgia which deals with muscles throughout the body that there could be some correlation between the two.  We can have muscle spasms anywhere on our body and the pain can be acute and they can be present mid-right back and right shoulder blade.

I think sometimes that if my body can spasm anytime; then why not with vital organs or even pancreas, gall bladder, etc.

I also have the tendency to constantly urinate.  I find it difficult to make plans just for the hour or even day.  When I go to the bathroom I really have to go - pain is unbearable.

I am aware that another symptom of Fibromyalgia is IBS - but why access urination all day long.

I would love to hear from anyone who has an idea to what step I should take to find out these conditions.

[Denise [e-mail]]

First of all I would like to say wow I didn't even know that there are so many people that have SOD. Thank you to who ever came up with this page. I have had the disorder on and off all of my life. The first attack I had was when I was 5 years old. I wasn't dyanosed (sorry my spelling sucks) with it until I was in my earily 30's. I have had a sugery that was supposed to relieve the pain and help the muscles to work better I think it was to sew the sphinter muscle open. That didn't work. I have tried  acidophilus but that made the cramping and dumping worse. Other then that the drugs mentioned by others on this page I have not tried. At this point the pain and vomitting when I have the episodes are so bad that they make me think death would be better. The last attack had me in the hospital for 3 months. I don't think I can go thru that again. Does anyone have anyother suggestions that have worked for them. I am willing to try anything at this point. My email address is above. If you would like to email me. Thanks! Denise

[Denise [e-mail]]

First of all I would like to say wow I didn't even know that there are so many people that have SOD. Thank you to who ever came up with this page. I have had the disorder on and off all of my life. The first attack I had was when I was 5 years old. I wasn't dyanosed (sorry my spelling sucks) with it until I was in my earily 30's. I have had a sugery that was supposed to relieve the pain and help the muscles to work better I think it was to sew the sphinter muscle open. That didn't work. I have tried  acidophilus but that made the cramping and dumping worse. Other then that the drugs mentioned by others on this page I have not tried. At this point the pain and vomitting when I have the episodes are so bad that they make me think death would be better. The last attack had me in the hospital for 3 months. I don't think I can go thru that again. Does anyone have anyother suggestions that have worked for them. I am willing to try anything at this point. My email address is above. If you would like to email me. Thanks! Denise

[Tana]

Hi, I have been experiencing pain like a gallbladder attack as well. I had my gallbladder out last September, but I still continue to have pain. My liver enzymes are all normal and all other tests are normal except my hida scan showed my sphincter of oddi was a 6. Evidently normal is 1 through 4. I am going to see a specialist in sphincter of oddi in 2 weeks. If he agrees with the diagnosis here then I believe he will cut the sphincter of oddi to stop it from causing me pain. I cannot take any pain medication vicodin or tylenol with codeine as it causes me extreme pain in which I went to the emergency room. Does anyone else out there have the problem with taking pain medication? Also, I would like to know where you are from that got a doctor to give you the calan SR and the nitrostat. I asked my doctor about the drugs and he said that they are not approved here (Illinois). I would rather try the drugs than to have my sphincter cut. I am afraid of getting acute pancreatitis. Also, my doctor said that I was a type III sphincter of oddi dysfunction since all tests are normal but I still have pain. Also, is there anyone who would share with me what they went through having the sphincter of oddi cut. I am very afraid to do this. I want to be put completely out to have it done.

[Elizabeth]

Being able to relate to you all in respect of pain after eating, gallbladder removal, sphincterotomy after two ERCP's, I am now left with a biliary system that spasms.  Each surgical procedure has left me in a worse condition so am reluctant to have any more unless there is a real chance of stopping the muscle spasms.
All data on the spasm aspect of this SOD condition indicates it is a difficult condition requiring "focal" treatment.  Anyone know what this is?
I am 75% sure this condition is worsened by stress as I feel so much better while on holiday, eating only three times per day and getting more excersise.

[Cyndi C.]

I am writing in desperation. I just got back from a GI doctor that I was referred to  who was supossed to correct my SOD dysfuction. I have also been through it all for the last 6 months. I was seeing a specilists that done ALL the test and found my SOD problem. Happy to drive 4 and 1/2 hours one way thinking this GI doctor would look over my book of records and schedule the procedure,etc. I was so relieved that we'd finally gotten to the bottom of this nightmare. After meeting with the GI specilists,ya know the whole talk deal. He thumped on my stomach, took me to his offoce and spent 2 hours TALKING about how all my medical history (I had a history of medical problems such as having a hysteroctomy, adhesions,lost 3 pregnancies,had 2 endoscopes, and ct scans,sonograms,and gallbladder test that ended in having my gallbladder removed were all misdiagnosis's of IBS. This was contrary to 3 other doctors opionion 2 of them being GI doctors. He than wrote me a prescription for depression medicine and sent me home. You can't even imagine how disguisted that made me feel. I'm lost for words. after returning home I looked up IBS, it doesn't even remotely sound like the problems I'm having. I have severe pain center to sometimes left(high under my center rib) that goes to the right and when it worsens it radiates around my back. It is a horrible pain that comes and goes,spasmitic. I spend nights in the ER, so sick, vomiting. I also have all other signs of SOD including high liver enzymes...etc. Just being able to read others who have the same problems really helps. I know it is not all in my head as he suggested, and I have as of Jan. made a new start as eating healthy including lot's of fiber and walking. I'm at the end of my rope. I think a lot has to do with the type of insurance a person has, I've heard stoies of how some patients are rushed through like an assembly line while others with a lesser complaint are taken more seriously. any comment would be appreciated. I am a 33year old female who like I said before am ready to just give up on the medical field, and try to handle this all on my own.

[barbara august 28]

I think you are right about so much surgey i have had my sphincter cut, four endoscopic done, medicines nothing helps ijust keep taking pain pills. I seem to get worse having all this done to me.I don't know of anything that can be done for this.I don't think the doctors know !!! Its is the worse pain to live with,i can't plan to do anything or just to have fun.Well anyway this is what i have my entire biliary tree is moderately severe,ampullary spasm/stenosis,pancreas divisum, i'm a mess and i've got to go back to mass general hospital to see if there is anything new they can do i'm sick of living like this!I WOULD like doctors to read what everyone has said on this page,iwonder if they really know how much pain we are in.I wish you all pain free.And i hope you all keep up with this page.

[Michelle1229]

A related discussion, RUQ pain after gall bladder removal was started.

[Siegeworks]

A related discussion, Sphincter of Oddi Dysfunction was started.