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Digestive Disorders / Gastroenterology Forum
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Avatar universal

Statistics on recovery rate after treatment for SOD dysfunction?

My mom is 57. She has had pain in her stomach increasing over the past couple years. Almsot a year ago she had her gallbladder removed. The pain has progressed more and more since. From what I've read about SOD on the internet I have a feeling it is SOD, but my dad, who is an internist, doesn't think so, nor does the "super specialist" in San Francisco think so. They think it's a motility problem. (The local GI specialist has given up.) All medication attempts have failed. All tests come back normal, CS, colonoscopy, MRCP, endoscopy. She has not had SOD manometry or ERCP from fear of complications, and because, like I said, the super specialist doesn't think that is what is going on. Despite that in the research I've seen it says only about 20% of patients who undergo the ERCP and sphincterotomy get pancreatitis, the super specialist in SF said in his experience he would say the number is more like 50%. He says if my mom got pancreatitis she would be in the more horrible pain imaginable and that she would "wish she had her old pain back." So hearing that doesn't exactly make he anxious to do it.
     The past few months have been a roller coaster. About two months ago my dad took her to the hospital at night because she was so naseated and sick. Her symptoms are constant RUQ pain and frequent (1-5 times a week) naseau. So she was hospitalized for days and that's when they did the most recent colonscopy. She's scared and depressed and not sure of how she can go on living like this.
     My question for you is, do you know how many people get better in the long term with these difficult cases? To narrow my question a little, how many people who get treated for SOD through spinchterotomy recover? That is to say including the ones who get pancreatitis after the operation as well as the ones who do not, what is the overal recovery rate? If it's good, then she can possibly look at the pancreatitis as a necesary path to get to a full recovery. Do you know what I mean?
     As far as where my dad is with this, (who is naturally her ongoing primary care physician) he is talking to a local surgeon who also knows about what is going on so far. The surgeon's only thought is to remove part of the colon. The surgeon says it is no garuntee, but it is all she can think of. Do you know of any cases where someone gets their colon removed because of these sorts of symtoms? If so, how often do they fuly recover?
     Your thoughts are highly appreciated.

     Adam
41 Responses
233190 tn?1278553401
MEDICAL PROFESSIONAL
There are several options to treating Sphincter of Oddi dysfunction.  Here is a summary for their success rates.

1) nifedipine - studies are not able to quantify its efficacy.

2) nitrates - again, no controlled studies are available to quantify the efficacy.

3) biliary sphincterotomy - small studies show 85 percent efficacy (measured in long-term improvement) vs 30 percent in the placebo group.

4) botulinum toxin injection - no studies are able to quantify its efficacy.

5) surgery - studies show a 50-60 percent efficacy, however there is a chance of worse outcomes.  

As to whether a colectomy is appropriate, it would depend on what disease is causing the symptoms.  I would consider a second GI opinion to determine whether SOD manometry should be considered.  Another, less invasive test to consider would be a fatty meal ultrasound.

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 patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
Medical Weblog:
kevinmd_b

Bibliography:
Hogan.  Treatment of sphincter of Oddi dysfunction.  UptoDate, 2004.
Avatar universal
Hey,
Sorry to hear that your mom is still suffering with her pain.  I was curious why a surgeon would want to take out part of someone's colon without clear evidence that something IS wrong with her colon.  did I miss something in one of your prior posts??  I wasn't aware that something showed during the colonoscopy....Hope she feels better soon.
Kris
Avatar universal
Dr. Kevin gave a pretty good answer for 16 dollars, but I was hoping he would answer the question about the eficacy of colectomy for patients with ongoing, mysterious stomach pain of the sort I described my mom is having.
   Kristin, I dont think you missed anything. The colonoscopy didn't show anything. What we're working with now is the fact that 1) The super specialist in San Francisco who is affiliated with UCSF medical school does not think SOD is the cause of her symptoms, and he does this stuff all day every day for years and years. His warning about pancreatitis and the potential for ongoing worsening symptoms after the procedure also don't make the ERCP/manometry option sound too good right now.
   As to your question about why a surgeon would suggest this. Well, the surgeon did something that is rare for a doctor to do. The surgeon asked my mom, "what do you think is going on?" My mom thinks it's her colon. The medical explanation for that feeling, from my dad, is that if the super specialist doesn't think it's SOD, then what else could it be? That is to say, sort of a process of elimination. The surgeon was actually suprised that the super specialist DIDN'T put a stent in when my mom went down to SF a few weeks ago. However, after reading his report, the surgeon said she could see why he would feel that it isn't SOD, and she admits he knows more about this than she (she had referred my mom down to him in SF). So with the super specialist not thinking SOD is the problem, but rather a motility problem, and with my mom's gut reaction (no pun intented) being that it's her colon which is causing the problems, the idea now is for the colectomy if her symptoms continue. She had a horrible day yesterday, exteeeemely nauseated for hours. Luckily she started feeling better and didn't have to go to the hospital. Today she isn't nauseated, but she is holding her side like she always does, the pain never really goes away completely.
   How about you, how have you been? What's been going on?
   Adam
Avatar universal
Has a GES been considered?
Avatar universal
whats a GES?
Avatar universal
As a surgeon who's performed tons of colectomies as well as other abdominal operations, I'd say there's nothing in the info you provided that suggests any role at all for colon resection. Perhaps there's more info. Based on what you've provided, I'd certainly NOT be considering such a thing.
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