Sphincter of oddi dysfunction

[melissa7807]

What kind of test(s) do they do to find out if it is SOD.... I am asking because my boyfriend is 40 years old
and he has been sick for 2.5 years and the docs can't figure out why he is so sick all the time and they
took his gallbladder out and he also had pancreatitus and has severe pain in the upper right quadreant
and is always vomiting from it and he alternates from having dirreah to constipation....the gastroenterologists
have no idea what he has they said he has had the million dollar work up.  However, a friend of ours was watching
the discovery health channel and she had the same symptoms as my boyfriend so he told us about it and I am almost positive that he had SOD... If there is anyone who can tell me the name of the test and what
do they do for it please let me know......thanks,   Melissa

[CalGal]

Melissa, when an ERCP is done your BF would be out - cold. So they wouldn't have to worry about him getting the tube down. It sounds like they may have been doing another kind of test such as the pH monitoring test. That's one in which you have to 'swallow' the tube, and it can be difficult for some people. It sounds like they're trying to test for GERD with the pH test, to find out if he's refluxing acid up, into the esophagus.

[Fuzzz]

I found this description of ERCP with manometry:  

With ERCP, the endoscope is passed through the mouth, esophagus, and stomach into the duodenum (first part of the small intestine). A small plastic tube, called a catheter, is passed through the endoscope and manipulated by the gastroenterologist into the bile ducts and pancreatic ducts. At this point, this catheter is connected to a small computer, that allows real time measurement readings of the pressures of the sphincter of oddi. Depending upon what is seen with respect to the pressure measurements, your doctor may or may not make a small cut known as a sphincterotomy. In addition, if something else is noted with the injection of contrast, biopsies may be taken via the scope. If a stone is found within one of the ducts, it may be removed, or if a stricture is present a stent might be placed.

In this way, ERCP often can avoid the need for surgery. Most patients have no discomfort and many patients fall asleep during the procedure.

[melissa7807]

  Sorry it took so long to get back things going on but anyway, We are in Middleburg, Florida and We have a great teaching hospital here.but they don't know what is going on with him and we really feel that he does have SOD. Is the ERCP  with menometry  a tube that goes down the throat and they test with it there for like 12 hours.... if so they were going to do that test but my bf couldn't get the tube down to do the test  so is there any other test they can do to find out if it is SOD?

[CalGal]

Here's a link that gives an overview of the condition: http://hopkins-gi.nts.jhu.edu/pages/latin/templates/index.cfm?pg=disease1&organ=3&disease=12&lang_id=1

The test that is used is an ERCP 'WITH' manometry. If the ERCP is done without manometry the 'results' may be useless and possibly detrimental to the patient on down the line. If the condition is SOD, seek out docs that specifically deal with the condition. You may have to consult with someone associated with a university affiliiated teaching hospital.

[ohiogirl]

Melissa7807 -
SOD can be a very difficult condition to dx.  There are three types of SOD, and the first two can be indicated by elevated liver and pancreatic levels in the blood.  Has your boyfriend ever had his blood taken to see if his panc enzymes are out of wack, or abnormal liver levels?  Type III shows only symptoms and can be dx'ed officially only by a procedure called ERCP.

It can be very difficult to find a doc that knows of SOD.  Much like that Mystery Diagnosis show on DH, most SOD patients go through a lot of problems while they are trying to figure out what is going on.

where are you guys from?  You need to find a GI who specializes in diseases of the pancreas, or at least knows of SOD and can refer you to someone who does.  Major centers that I trust are in North Carolina, Minnesota and Indiana.

It's not a fun condition to have, but there are meds he can try to relax that SO muscle and help with pain if ERCP isn't right for him.  Levbid is a med that is an antispasmodic which sometimes helps to relax that muscle, and Elavil is an antidepressant that is prescribed nowadays to help the body cope with pain.  When taken together, some people have a lot of luck with them.  on the flip side, I have heard of others who didn't react to them, but heck...if he hasn't tried them, its worth a try.  There are a few different ways to take the Levbid, but I always recommend that people take the 12 hr extended tab dose.  

Good luck, I'll be thinking of you.  I have SOD as well, and it can be a long road.

[ak832]

I'm not a doctor, but I believe the test is a lower endoscopy.  Basically the send a small camera up the intestines to see if it is functioning properly.