Sphincter of Oddi: what is it, why does it spasm

In the duodenal papilla of the duodenum there is a valve, in medicine it is called the sphincter of Oddi. The main function of this muscle valve is the regulation of the incoming pancreatic juice and bile. It also prevents intestinal contents from entering the bile ducts.

If the main functionality of the sphincter or motility is disrupted, an atypical outflow of pancreatic juice and bile occurs. Such consequences are possible in people after cholecystectomy.

Disruption of the sphincter of Oddi

The difference in the type of dysfunction will depend on the underlying symptomatology:

• biliary. Signs of bile duct stenosis predominate;
  

  What does a bile duct stricture (stenosis) look like?

• pancreatic. The symptoms of pancreatitis come to the fore.
  

  Signs of pancreatitis

Typical symptoms are painful sensations arising in the right hypochondrium or epigastrium, lasting from half an hour to several hours. Sometimes the pain can radiate to the shoulder and back. Soreness occurs after eating or as a result of taking narcotic analgesics.

It is possible that dysfunction may appear after cholecystectomy (in this case, the symptoms will be similar to the preoperative period). Palpation reveals insignificant sensitivity in the epigastric region or the right side. Symptoms resemble those of acute pancreatitis that recurs.

Diagnostics

To confirm the diagnosis, a number of studies are established.

Table. Research methods

Research method	Short description
Laboratory test	Almost half of all patients suffer from increased levels of enzyme activity in the blood (pancreatic or hepatic). The level rises when an attack of pain is felt and decreases in sync with a decrease in the level of pain.
Imaging techniques	In order to detect the expansion of the bile ducts, ultrasound is used.
Manometry	It is a fairly accurate research technique and fully confirms the diagnosis, however, it is very inaccessible to the extent of technical difficulties, and also entails many consequences.
MRPCG (Magnetic Resonance Cholangiopancreatography)	Used to detect narrowing of the bile ducts.
Endoscopy	Through this research method, the duodenal papilla is examined. In this way, oncology is excluded.
Endosonography	It is used to detect microcholelithiasis, shows any biological changes in the intestinal papilla.

Diagnostic criteria

To determine the dysfunction of the sphincter of Oddi, there are "Roman" criteria III, they include: attacks of painful sensations, precise localization in the epigastrium, as well as the presence of additional criteria.

Additional criteria

1. Episodicity of pain over half an hour.
2. The manifestation of symptoms after a period of time.
   

   Soreness occurs at regular intervals

3. Increasing painful sensations.
4. Lack of relief after stool.
   

   Pain does not decrease after a bowel movement

5. Persistent discomfort even when changing body position.
6. Failure to relieve pain by taking inhibitors and antacids.
   

   Antacids do not relieve the condition

Attention! Additional criteria may include symptoms such as sudden nausea, severe pain radiating to the right shoulder blade.

Why does sphincter spasm occur?

This is a pathological condition of the patient, which is acquired in nature. Explained by muscle dyskinesia. The clinical picture of spasm is very similar to the symptoms of stenosis of the sphincter of Oddi. The latter is provoked by structural disorders.

With a spasm of the muscle fibers of the sphincter, hypertonicity is noted. As a result, increased pressure in the pancreas and biliary ducts.

Experts have no explanation for the prolonged spasm. The most accurate provoking factor is the inflammatory process of the duodenal papilla, or duodenitis.

Reference! The risk group mainly includes women aged 30 to 50 years, who are exposed to frequent stress, have an asthenic physique or insufficient body weight.

Distinctive symptomatology

The primary and one of the main symptoms of the pathological condition of the sphincter of Oddi is recurrent pain directly in the hypochondrium (on the right side) or in the epigastrium. In addition, there is frequent nausea, which often leads to vomiting.

Relapses can occur after a few days. Often an attack occurs precisely at night. It is also characterized by complete intolerance of the digestive system to fatty foods.

On an individual basis, there may be a connection between food intake and the occurrence of painful sensations. With pathology, in general, an attack manifests itself two to three hours after a meal. Thus, the patient is able to track what kind of food triggered the attack (observed after eating fatty or spicy foods).

When collecting an anamnesis, a specialist often reveals a previously performed cholecystectomy. It is after this procedure that patients experience spasms of the sphincter of Oddi. To eliminate the pathology, surgical intervention is indicated, after such treatment, the pain is significantly reduced, but it can resume after a while.

How pathology is treated

Treatment for patients suffering from sphincter of Oddi dysfunction is carried out exclusively on an outpatient basis. In case of acute pain, urgent hospitalization is indicated. The patient is referred to the gastroenterology department.

The therapy is based on manipulations to relax muscles and the use of drugs to block pain. Further, the course of therapy includes taking medications that normalize the level of pancreatic juice, as well as the outflow of bile.

The diet must be changed. The patient is assigned diet therapy. First of all, you need to forget about spicy and fatty foods. It is she who provokes painful conditions. It is also prohibited to eat onions and garlic in any form. It is not recommended to eat food with spices.

Recommendation! It is imperative to normalize body weight and give up bad habits. This will help ease the pain during an attack.

Medicinal effects

To block the attack, experts prescribe nitrates or anticholinergic drugs (Methocinia iodide).

It is obligatory to take antispasmodics ("Drotaverin" or "Papaverine"), since the pain is unbearable for the patient.

Additionally, a group of calcium tubule blockers ("Nifedipine") is used.

Attention! Due to the fact that drugs have increased side effects, experts attribute them in low dosages. That is why self-medication and self-administration of dosages are categorically contraindicated. The patient can only aggravate the indications of the clinical picture.

To block the spasm, "Gimecromon" can be attributed (also characterized by an excellent choleretic effect), and "Mebeverin" is excellent for normalizing the selectivity of the sphincter.

If the effectiveness of conservative therapy is minimal, then the patient is recommended to carry out surgical treatment. At the moment, there is an alternative manipulation - injecting botulinum toxin into the sphincter of Oddi.

What predictions

With effective treatment of a pathological condition, experts note only a favorable outcome. Since long-term drug therapy can significantly improve the clinical picture and normalize the patient's condition.

However, it should be noted that there are no preventive measures in this case. In general, rational nutrition is recommended (fractional nutrition should prevail), normalization of body weight and timely treatment of various ailments of the gastrointestinal tract.

It is also very important to completely quit smoking, because this aggravates the patient's condition with spasm of the sphincter of Oddi.

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