Hello - thanks for asking your question.
I have researched previously on SOD and post-cholecystectomy syndrome. I will reprint my research here.
The term postcholecystectomy syndrome (PCS) describes the presence of symptoms after cholecystectomy. These symptoms can represent either the continuation of symptoms thought to be caused by the gallbladder or the development of new symptoms normally attributed to the gallbladder. PCS also includes the development of symptoms caused by removal of the gallbladder.
Two types of problems may arise. The first problem is continuously increased bile flow into the upper GI tract, which may contribute to esophagitis and gastritis. The second consequence is related to the lower GI tract, where diarrhea and colicky lower abdominal pain may result. This article mainly addresses the general issues of PCS.
PCS reportedly affects about 10-15% of patients. A wide range of symptoms occurs. Symptoms are sometimes considered to be associated with the gallbladder. Colic is found in 93% of patients, pain in 76%, jaundice in 24%, and fever in 38%. The cause of PCS is identifiable in 95% of patients.
The workup for PCS is variable. An extensive study of the patient should be performed in an attempt to identify a specific cause for the symptoms and to exclude serious postcholecystectomy complications. Surgical reexploration should be considered a last resort.
The treatment depends on what is found on evaluation - it will vary depending on what the cause of your symptoms are.
My previous research on SOD can be found here:
I stress that this answer is not intended as and does not substitute for medical advice - please see your personal physician for further evaluation of your individual case.
eMedicine - Post-cholecystectomy syndrome
a certain percentage of sphincterotomies will scar down over time; another ERCP might be able to determine this. It can become a difficult problem, because SOD is still not fully understood, and manometry, etc, are only partial indicators. So when symptoms persist after treatments such as you have had, it gets increasingly difficult to pinpoint the cause. However, having had what sounds like an improvement from the sphinterotomy, one might consider looking into the anatomy of the area again.
Although I have not had the SOM and sphincterotomy procedure, and as such my SOD is presumptive, my symptoms began the day after my gall bladder was removed in 1999 and are identical to yours - excruciating epigastric pain that radiates to the RUQ and back, beginning with hunger pangs about 3 hours after the last meal. I am also awakened most mornings (5-6 a.m.)with a pain in the back that quickly escalates into the usual severity and location if I don't address it. All the scopes w/biopsies and CT and MRCP and liver enzyme blood tests normal. You might try the couple of things that work for me. At the very first sensation of hunger pang,(if you've learned to live with this you recognize it very easily) drink a tall glass of water. Eat smaller, more frequent meals, rather than 3 regular meals. If I am stuck without water or food (as I was recently when stuck on a plane on a runway awaiting a delayed takeoff), two levsin, .125 sublingual (under the tongue), at the very first sensation, will work for an hour or so.
Hope this is useful. What the previous poster said about scarring of the sphincter causing restenosis following sphincterotomy is reported in the SOD literature.
I HAVE HAD THE SAME PROBLEMS AS YOU....AND ALSO THE SAME TESTS SINCE MY GALLBLADDER REMOVAL IN FEB.2000. MY M.D. PUT ME ON QUESTRAN LIGHT BID...TASTES TERRIBLE ...BUT IT MAKES LIFE BEARABLE. MY HIDA SCAN FUNTION WAS 3%..SO THEY FIGURE SOD..BUT I WILL NOT DO ANOTHER ERCP...BESIDES ..IT SEEMS EVERYONE SYNPTOMS COME BACK AFTER FIXING THE DUCT..HOPE THIS SUGGESTION HELPS.
Have you had elevated liver enzymes recently with an attack of pain? I'm curious because I just had my 2nd ercp and the dr. had to do a generous sphincterotomy just to access my bile duct.
One hour after I awoke from the surgery I was back in the ER room with a severe attack again! Of course they thought pancreatitis, as so did I, but blood tests revealed only elevated liver enzymes again. Of course the dr. was stumped and put me on an anti-inflamatory for 2 weeks, with pain meds. I feel alittle better each day but noone can explain the elevated enzymes with colic (after the procedure). The dr. said I should have felt fine. I should mention also that he had to clean my bile duct too. There was high grade stenosis. My only conclusion is that my duct swelled shut after the procedure, causing my bile to back up into the liver temporaily. Does this make sense ???
I was on questran for about 7 months. It did work for me, but had to stop taking it because I no longer had a problem with loose stools. I've switched to taking metamucil when needed. It seems to bind everything up and give me the full feeling my body needs. I choose not to take it daily - I don't want my body to become dependant on it. My liver ensymes came down into normal range after my sphincterotomy. I went in during one of the attacks and checked out fine. I figure I will let this take its course as long as I can then go in and have it done again. Like I said the pain isn't nearly as bad as it was.