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Gastroenterology (Expert Forum)
sphincter of oddi dysfunction
This forum is for questions regarding Gastroenterology issues such as Acid Reflux (GERD), Barretts Esophagus, Colitis, Colon/Bowel Disorders, Crohn's Disease, Diverticulitis/Diverticulosis, Digestive Disorders, IBS, Stomach Pain.
sphincter of oddi dysfunction
by ttcoffin, Sep 29, 2002 12:00AM
Has anyone had the test to diagnose this? I have read alot about it and it seems risky. Says it can actually cause chronic pain and it can cause pancreatitis. I was wondering if anyone here has ever had it and how it turned out? My husband has had a liver biopsy recently and it turned out just confirming fatty liver. HIs liver enzymes are elevated and I read that could be from the sphincter of oddi dysfunction also. He has had CT scans, scopes, colonoscopy's,upper GI with small bowel follow through. He had his gallblader out almost 4 years ago, felt good for about 2 weeks, and then started getting pain in his upper middle stomach area. Not the same pain as the gallblader pain, and not the same area. He has been diagnosed with chrons disease, low thyroid, fatty liver, barretts esophagus,high cholesterol but they still cannot find the cause of this pain. It always aches but hits hard after eating(about 30 minutes). I have thought for along time,that it was his pancreas but his enzymes came back only one point low.(although this was not doen during an "attack"). Someone on here mentioned the sphincter of oddi dysfunction and it sure seems to macth his symptoms. He is also scheduled for a CT scan of the neck and chest next friday, to check for lymphoma. He has lots of swollen lymph nodes! Please let me know if anyone here has had that test. Thank you........Tanya
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I had my gallbladder out in Nov of 2000. The day It was taken out I developed this horrible pain just below the sturnum. SOD can cause pain either when the stomach is empty or right after eating. Mine was always when my stomach was empty. The pain would always come on very suddenly, and everynight between 12am and 4am. I spent a year and a half sleeping sitting up , because when I layed down it would make the pain worse. This pain would cause me to sweat all over my body. There were times when the pain got so bad I would forse myself to throw up just to relieve the pain. It would bore into my back just as bad as the front hurt. I searched going Dr to Dr for someone to tell me what was causing the pain I've had 2CTs, upper GI with small bowel follow through,2 Hida scans, 2 gastric emtying scans, 4 scopes , and an ERCP all normal. One Dr thought my pain just couldn't be as bad as it sounds - 3 others said it was IBS to get me out of their office. Then one had no clue so he refered me to the Borland Groover clinic to see a biliary specialist. BINGO!! He knew when I walked in his office what was wrong. A year and a half later I felt like a weight was taken off my shoulders. I had the ERCP with menometry done found out my pressure in the duct was way high and he made a cut in my sphincter and the pain was gone. I did end up the next morning back in the hospital with pancreatitis for 3 days, but like I said it was well worth it. I am now having some pain again, but not anything like what it was. I might have to go back and have it done again - I sure will if it gets to bad. By the way SOD is usually found in people who had a non functioning gallbladder , and I too had a liver liver test. This procedure works the best with people who have more than just the pain. Pain plus the high liver has better results.
Sorry for the long post but it sure is nice to hear about people who have similar things going on. Thanks again.........Tanya
My SPhicture pain also started right after gallbladder surgery. They said my gallbladder had sand in it.
What brings my attacks on are medicines, i.e. codeine, vicodin that the dentist gave me, so i was told that i could not take any narcotics as this causes the Sphincture of Odie to clam up and delay the emptying. I have also noticed that at times, aspirin and ibuprofen can bring on an attack.
I had an ERCP done many years ago and the 45 minute film did show the reaction in the sphinture when a narcotic of some sort was administered. They sufggested going to a place in Wisconsin that takes care of these problems. I chose not to go as it was to far from home. Now, they have experts around the country that do this.
I a CT scan done of the stomach a few months back. it showed dialation of the duct. The Radiologist told my gastro lady to order an MRCP/MRI of the area or an ERCP. She chose the MRCP. That showed negative. She told me that of it had shown something she would of referred me to a Biliary expert. Apparently general gastroenterologists do not treat this condtion
and besides, this is such a delicate area..one would want to see a good biliary doctor anyway. Good Luck to you.
My question is: does SOD's pain come up to your throat? My doctor said it shouldn't and the bloodtest shows normal liver function so he said the pain shouldn't be to do with gallbladder. What are your opinions? Before you took your gallbladder out, how did you find out your gb is not functioning? Did the bloodtest show any abnormal liver function?
Thank you very much! Waking up three to four times every night is just so tiring and debilitating. I get tired really easily as well. Any answer is much appreciated.
Sorry this is so long, I am just so relieved to find that other people have been going through the same thing I have. PS: haven't lost any weight with the Metabolife, but like I said, it makes my stomach quit hurting so I don't feel like I'm going to throw up.
Sorry but I could not help posting a note. I have been reading these posts for about a year now and have posted from time to time. When I read your recent post on SOD and your symptoms, I had to look at the nickname to see if it was me. I too have had the same thing for 4 years now. It started about 5-6 hours after my gallbladder surgery. I awoke with this horrible pain up under my sternum and could not talk, breathe, or move. I thought I was having a heart attack. I stayed an extra day in the hospital and all the dr. said was that I had a rough night! He had no idea! I had these attacks for 2 years (always during the middle of the night) and would occassionally see my regular dr. and he would adjust my prevacid and said it was severe acid reflux. I didn't beleive him at the time. Anyway 2 years ago I had my first attack during the day(while I was driving with my kids). Luckily my mother was with me and ruched me to the hospital. It took them approximately 4 hours of demoral and ativan shots to calm down the spasms. After blood tests and ultrasound he concluded I have SOD dysfunction. I had an ERCP done 2 months later but the specialist said my pressure reading was only 30 something and I needed to be 40 or higher to cut the sphincter. I was so upset because I really thought I had found a cure (even a temporary one). You said you had an ERCP that showed nothing too. (your first one) How did you go about getting ahold of this borland groover place and making an appointment etc. I hope you don't mind me asking these questions. I too sleep upright and have been for 3 1/2 years now. I still get the onset of these attacks but I take Donnatal and it keeps my pain about 6-7. The medication keeps me out of the ER room so I take it, till a dr. can put an exact label on what I have. I truly beleive I still have SOD with severe spasms. Sorry for the long note. I just could't beleive someone else on earth was going through the same thing. Thanks.
When he came in to the room for my appointment he sat down and said "I'm sorry I can't tell you what you want to hear - I don't know what's wrong with you".
He said I fit one of the criteria for SOD to a T - the pain. He said he is a little concerned because I do not have elevated liver enzymes and my bile duct "isn't any more dialated than you would expect to find in a person who had their gallbladder out"
My history goes pretty much like this:
I just spent 6 days in the hospital (beginning 09/26/02) for pain - URQ, follows the rib cage up to the middle of the body and then radiates into the back. A lot like the attacks I had when I went to the ER with pancreatitis and gallbladder. The best way I could describe it to the doctors is having someone punch me in the diaphragm and then not removing their fist. The pain is worse with food intake - ususally starts like spasms in the right and then the pain increases from there, turning into stabbing pain.
I was put on morphone because the GI cocktail, Demerol and Phenergan didn't touch the pain and nausea. I was admitted so they could "find the problem" without having to endure the pain for the time it would take to schedule the tests outpatient. At the time I went to the ER I had not eaten since the day before and was vomiting bile. I have been living on Coke heated in the microwave and then stirred until it is flat because it seems to be the only thing that helps settle my stomach.
I was on either on a clear liquid diet or NPO (nothing) for five of the six days I was in the hospital. Only the last day was I given a "liquid diet" for two meals and then solids for the last meal.
My amylase and lipase levels were not elevated, my hepatic function tests were normal as was my urine sample. I went through abdominal x-rays, gastric emptying test, small bowel follow thru, and a MRI that zeros in on the bile duct (MRCP I believe). They were all "okay".
Unfortunately (or fortunately, depends on how you look at it) my Gastro practices in a group with three others. I never did see my specific Gastro in the hospital. I did see all of his partners.
Once they ruled out that there wasn't "sludge" blocking the common bile duct (by the MRI) they seemed to decide that that was the end and they would discharge me.
I did ask the Gastro who visited me about chronic pancreatitis but he just pushed me off saying that my A&L levels and hepatic functions were normal and that "you don't want chronic pancreatitis". I guess since I have "perfect cholesterol levels" and am not a heavy drinker he feels that this is not a possibility. I had pancreatitis when I presented to have my gallbladder out - it took four days to control it and I was questioning if it was possible the pain was from Chornic. I had read you didn't have to have elevated enzymes.
The pain still continues. The admitting MD finally put me on Reglan to try to get me to keep three meals down without vomiting. Once that was accomplished I was discharged. I was at the point I would have lied and said they stayed down even if they didn't because it was obvious the doctors I had were not going to go any further. They want to blame it all on the severe gastritis I was diagnosed with. They have increased the meds I take to: Nexium 40mgs 2X a day; Librax 5X a day (for IBS); and added the Reglan (1/2 hour before every meal).
The surgeon who did my gallbladder surgery (in July 2002 - I spent six days in the hospital then too, due to pancreatitis)(he's a colon and rectal specialist) seemed to be more interested in what's wrong than the doctor's in the hospital did and he really doesn't have a lot to do with my care at this point - the surgery is over. He did want to review my latest CT himself and wanted me to return in four weeks (I saw him 3 days before I ended up in the hospital). He asked me if I had had an ERCP done and I told him no. He said something just wasn't right. I did have a nicked artery during surgery so my recovery was a little different than most. He also check for a hernia and said he didn't find one.
I cannot tell you now happy I was not to hear the GI say "you'll just have to learn to live with the pain" and "IBS". He still thinks that I present a pretty clear case of IBS, but he also feels that there is something else wrong that is causing this pain. He also now feels that whatever is wrong is what most likely caused my gallbaldder and pancreatitis problems. (Basically, they were just a flag of something else being amiss).
After such a long post - I hope it makes sense - I tried to cut and past from other posts so I wouldn't have to type as much. I'm a legal assistant and by the time I get home typing is one of the last things I want to do - my question for you is did you have more than one criteria for SOD: pain, elevated enzymes and/or dialated bile duct?
My doctor did give me Davrocet for the pain because I had been taking so much Advil, Alieve, etc. he doesn't want me to damage my kidneys or make my gastritis more severe.
Also, at times did your pain feel like muscle spasms/contractions?
My GI was go impressed by what I already knew about SOD when he was explaining it to me he asked if another doctor had discussed it with me. I told him that I had been on a message board for GI complaints and that I had done a little research - believe it or not he was actually HAPPY! He wanted to know if I had any questions about what I read that he could help answer. He wasn't offended at all - I expected him to be - you know how some doctors can be.
SORRY FOR SUCH A LONG POST, BUT SOMETIMES I THINK YOU NEED AS MUCH OF THE PICTURE AS POSSIBLE TO RESPOND.
THANKS,
5FAN
I did have an ERCP previously, but it didn't have the menometry part to it that measures the pressure in the bile duct. Find out if you had the "ERCP with menometry" or the "ERCP". There is a big difference and most places can't do the menometry. My liver was elevated slightly. You have a better chance of cure if your levels are even slightly elelvated. By the way I saw a Dr last year at Shades in Jacksonville. He told me he believed my pain was brought on by me thinking I would have pain in the middle if the night. Then when he heard that my more severe attackes were right around my period. He said I should start taking birth control pills. Needless to say I never went back.
Since I had my sphincter cut in April. I have had 2 attacks just recently. I thought I would have to go in and have it done again, but it since has gone away. I feel so much better. Still have alittle discomfort when my stomach is empty, but it just doesn't compare to what I had gone though in the past.
Having elevated live enzymes if your pain is from SOD - is a clear indication something is going on in there. In fact gives you a much better chance of recovering from having a sphincterotomy done. My 2 attacks I had recently were just like the ones I use to get. I started feeling almost like a bubble was forming just under the sturnum. Then wham the pain started and so did the sweat. The first one I was driving my car with my kids I had to stop at a gas station and get a coke to help relieve the pain. The next one was in the middle of the night and just seemed to last forever. That was 2 weeks ago and haven't had any symptoms since. I've tried levsin,elevil, demerol, percocet nothing helped.
By the way my glucose levels were raised also. I haven't figured out if that is part of it or not.
The second pattern is when a person has intermmitent pain like with acute pancreatitis.
I feel extremely fortunate to have a diagnosis made in only 8 months. I can only imagine what some have been through waiting for years and not knowing.
Lor--have you read anywhere (I have) that a spinchterotomy can cause longterm problems with, for lack of a better word, splashback of the partially digested food and juices into the ducts?