Sphincter of Oddi dysfunction: an evidence-based review

Abstract

Sphincter of Oddi dysfunction is a painful syndrome that presents as recurrent episodes of right upper quadrant biliary pain, or recurrent idiopathic pancreatitis. It is a disease process that has been a subject of controversy, in part because its natural history, disease course and treatment outcomes have not been clearly defined in large controlled studies with long-term follow-up. This review is aimed at clarifying the state-of-the-art with an evidence-based summary of the current diagnostic and therapeutic approaches and modalities for sphincter of Oddi dysfunction.

Keywords::

• Modified Milwaukee Criteria
• obstructive disease
• Oddi dysfunction
• pancreatobiliary ducts
• ROME III Criteria
• sphincter of Oddi

Acknowledgments

The authors thank S Yu for his assistance with literature review and contribution to the treatment section of this manuscript, and Anita Rainwater for secretarial assistance.

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• • Sphincter of Oddi dysfunction (SOD) is a benign, non-calculus obstructive disease that has been a subject of controversy.

• • Common conditions causing right upper quadrant pain should be ruled out in patients with suspected SOD.

• • Modified Milwaukee and Rome III criteria are most clinically relevant classification systems.

• • Non-invasive testing should be considered initially to avoid ERCP and manometry related complications.

• • SOD should be considered in the differential diagnosis of recurrent idiopathic pancreatitis.

• • Pharmacological therapy may be a good initial approach in the management of SOD.

• • Type 1 SOD patients have excellent response to sphincterotomy.

• • Large randomized trials with long-term follow up are needed for clearing controversies associated with this disorder.

Notes