sphincer of oddi question

[weebles]

hi

I had the scan test with the mophine to test for SOD..............it came back showing with a dual enjection fraction of 10% and the report letter said that this is quite significant...............excalty what does the 10% mean?  is it only functioning at10% and thus hardly letting any bile out?

besides from SOD pain i keep getting inflamation in my tummy gstritis would this be because of the SOD effecting digestion?  I alrready take losec PPI twice a day for acid and it works for reflux but not helping inflamation

[UK892]

I had ERCP and sphincterotomy in April, with a repeat ERCP in October, after which on December 4th I had a third ERCP where they also opened the bile and pancreatic duct further, I am hoping this will be the end of SOD, but so far the releif has been short lived.  I got acute mild pancreatitis about four weeks after the third ERCP (started the day i had the snent removed, i did not get it after the other two procedures, although I am due to have the stent removed tomorrow so there's still time.

[weebles]

oh little....the test i had was AFTER my GB was removed it was a neclear scan where they injescted me with dye and i lay there for ages then they enjected morphine into me................all i know is my results said that quote  "the dual fraction reading was 10% and that this was extremely significant and indicated SOD"....the spec i will see will hopefully do an ERCP mamortory and splincer thingy!!

[weebles]

thanks everyone...yes i had a lucky break with the hilda scan by the sounds of it.  the nardi test is a very old test and not that relaible but apperantly if you do have a postiive reaction it veers will for a successful ERCP.  my appointment has been changed for tomorro which is a bonus..have taken today off work as not feeling to well.....i guess i will hopefully get some questions answered tomoro then.......i never thought about putting morphine down as an allergy what  a good idea!!! codiene set my first attack well it made me worse..i was already  having an attack.....i get pain after eating or just whenever really!  funny i cant llie on my back which was the same when my GB was playing up..............

oh im in new zealand so hopefuly the spec im seeing has had heaps of expereince with ERCP....i think i heard that its about 5% chance of developing pancreatis anyone know if this is true...

thanks
ness

we are doing IVF so dont really want to have issues with my SOD while doing this....IVF is stressful enough without stomach pain on top of it!!!!

[ohiogirl]

Wow...lucky break on the HIDA scan!  I also do things the odd way although my SOD flared up after GB removal, it's at it's worst when I am hungry.  I basically can't let my stomach get empty or else I know I'll have an attack.  My doc says it's conventional, but not unheard of.  I also went to a big city doc - Indiana University.

Weebles...I am sorry, I am not familiar with the Nardi test, I dont' think they do that in the states but I'd love to read about it.  I did know that there is a high sensitivity to Morphine however and whenever I am in the hospital for anything (i.e. when I had my last child) I list Morphine as an allergy so that if I am not in a state where I can communicate, they still wont' give it to me.  Please be careful and cautious with your ERCP.  Your doc performing it shoudl have performed literally thousands of them previously to be considered experienced.  the more experience the doc has, the lesser chance you'll have for pancreatits following.

I have to imagine that everything being all irritated in your gut relating to SOD is probably contributing to your gastritis.  Any sort of back up in there will get that SOD flared up, and just irritate anything else too.  

Good luck on the 24th!  I'll be thinking of you, keeping you in my prayers that everythign goes well.  Please keep us posted.

[little57]

To answer your question, the Hida Scan showed that the SOD was not opening, This was a fluke as they usually can't see that with this test. When I had the ERCP done, they found that it was blocked with scar tissue, which they cannot tell me what caused it. So they cleaned it out and cut it. No guarantees it won't come back. I also was told about the possibility of pancreatitis when they did this. I had to stay a few hours just to make sure it didn't happen. My gallbladder seems to be just fine, I actually thought that it was my gallbladder and was surprised to learn it was SOD. It's not a very comfortable thing to have and I do still have episodes of spasms, but nothing like before, I can actually eat now. I always seem to do everything the unusual way. The doctors are always surprised. The ERCP was not a comfortable thing to have done, I woke up twice during the procedure. I had lost so much weight, that they had to be careful of how much drugs they gave me, but I was being monitored very carefully and was immediately put back to sleep. I also had to go to a big city hospital to have this procedure done. I am also lucky that my GI Doctor specializes in this procedure. I hope this answered all your questions. Like I said, I do everything the odd way. LOL

[weebles]

hi thanks for your replys

to answer your questions i had a specific test for SOD called:The morphine–prostigmine provocation (Nardi) test for sphincter of Oddi dysfunction. im in NZ not the states....


it involved getting a nuclear scan and then getting morphine put into me and measuring the splincer of oddi reaction...this test shows if the splincer goes into spasm........as morphine based drugs are bad for SOD.

I had my GB out in jan this year and then i had an attack ten times worse about 6 weeks after....i went to emergency.....the pain was exactly like a GB attack......

hence i got the SOD test which came back with a 10% reading so i think that this means that the bilary tube that lets out the bile the Sphincter is tight,,im not really sure what the dual enjection fraction of 10% means which is why im trying to find out.....

I have had litle managable attacks and pain since............i find that i cant take anything that increases bile flow like natural stuff such as licorice root as it cause my splincter to give me sternum and right side pain/ache.

oh my GB came out cause it was nonfunctioning...i onlyhad one stone but thick sand sludge stuff,,,,,,,and losec is a proton pump inhibter like your proselic or nexium..

i have been referred for a splincter thingy mamortory where they cut the muscle but not seeing spec into 24 dec..

i really want to know if its worth doing and if it is fact is also causing me gastritis or if that is simply from acid...

[ohiogirl]

I'm not trying to be difficult, but a HIDA scan cannot deterine SOD.  SOD is not a blocked bile duct.  It's when the Sphincter of Oddi muscle spasms and contracts and does not allow the pancreas to release all of the good stuff it needs to like bile and insulin.  It's very painful when these spasms occur, just as a blocked bile duct is.

An ERCP will clear a blocked bile duct however.  ERCP with manometry is where the insert a tiny pressure measuring device into the opening of the SO muscle and use dye to make that muscle spasm.  Based on the readings, that's what can determine SOD.  if the doc gets a high enough reading, they will try to do a sphincterotomy where they actually score that SO muscle so that it cannot contract so much.  

It doesn't work well and no doc will tell you it's a cure.  There are high risks of Pancreatitis (an acute attack to full blown chronic) following this procedure.  

Little57 - do you know what your blockage was caused from?  Gall stone, or sludge?

[little57]

I just had an ERCP to fix a blocked bile duct to pancreas, which is SOD. I had a Hida Scan done which accidently showed it wasn't my gallbladder but SOD. At the near end of the test they caught the fact that the bild duct was not opening, which is very unusual. The ejection fraction of 10% would be for your gallbladder. It's suppose to be 35% or higher for your gallbladder to be working properly. Do you know the name of the test you had done? These are just a guess on my part because you never said what the name of the test was. PPI's don't work well until the problem is fixed.

[ohiogirl]

Weebles,
What is the scan test that you had done to detect SOD?  Was it manometry during an ERCP?  As far as I know, that's the only true test to Dx SOD.  And, my apologies I don't know what losec PPI are...can you help me there?

Where do you go for your testing?  I went to IU, Indiana University.

[weebles]

anyone out there