Sphincter of Oddi dysfunction and bile duct microlithiasis in acute idiopathic pancreatitis

Abstract

Although there are numerous causes of acute pancreatitis, an etiology cannot always be found. Two potential etiologies, microlithiasis and sphincter of Oddi dysfunction, are discussed in this review. Gallbladder microlithiasis, missed on transcutaneous ultrasound, is reported as the cause of idiopathic acute pancreatitis in a wide frequency range of 6%-80%. The best diagnostic technique for gallbladder microlithiasis is endoscopic ultrasound although biliary crystal analysis and empiric cholecystectomy remain as reasonable options. In contrast, in patients who are post-cholecystectomy, bile duct microlithiasis does not appear to have a role in the pathogenesis of acute pancreatitis. Sphincter of Oddi dysfunction is present in 30%-65% of patients with idiopathic acute recurrent pancreatitis in whom other diagnoses have been excluded. It is unclear if this sphincter dysfunction was the original etiology of the first episode of pancreatitis although it appears to have a causative role in recurring episodes since sphincter ablation decreases the frequency of recurrent attacks. Unfortunately, this conclusion is primarily based on small retrospective case series; larger prospective studies of the outcome of pancreatic sphincterotomy for SOD-associated acute pancreatitis are sorely needed. Another problem with this diagnosis and its treatment is the concern over potential procedure related complications from endoscopic retrograde cholangiopancreatography (ERCP), manometry and pancreatic sphincterotomy. For these reasons, patients should have recurrent acute pancreatitis, not a single episode, and have a careful informed consent before assessment of the sphincter of Oddi is undertaken.

A CLINICAL STUDY ON ACUTE PANCREATITIS AND ITS DIFFERENT ETIOLOGIES IN BOWRING & LADY CURZON HOSPITALS, BENGALURU

“…[9] Excessive alcohol use as a cause of pancreatitis is more common among men than women; the association between alcohol consumption and acute pancreatitis is complex but appears to be dosedependent. An increase in acute pancreatitis secondary to chronic alcoholism was confirmed by a study conducted by Trapnel and Duncan.…”

Biliary Dyspepsia: Functional Gallbladder and Sphincter of Oddi Disorders

“…There are no laboratory or imaging abnormalities b. Functional Pancreatic Sphincter of Oddi Disorder [65,66] Pancreatic-type SOD encompasses patients with pancreatic-type pain, elevated serum amylase or lipase plus pancreatic duct dilation.…”

Idiopathic Acute Pancreatitis and Sphincter of Oddi Dysfunction: Diagnostic and Therapeutic Role of ERCP and Sphincter of Oddi Manometry

“…Pancreatic SOD classification is analogous with type I defined as pancreatitis with dilated pancreatic duct > 6 mm in the head or 5 mm in the body [68]. Manometrically, SOD is typically defined as an elevation in basal sphincter pressure > 40 mmHg, although some have argued that peak pressures and phasic wave frequency should be considered [10]. In theory, pancreatic SOD causes elevation in intraductal pressure, thereby triggering premature activation of pancreatic enzymes and AP.…”

“…These may include medications, hypertriglyceridemia, hypercalcemia, infections (viral, bacterial, fungal), autoimmune/inflammatory diseases such as autoimmune pancreatitis or systemic lupus erythematosus, ischemia, and postoperative or other trauma (Table 14.1) [8,[10][11][12][13][14][15][16][17][18][19]. Consequently, for patients presenting with their first episode of AP, the initial management strategy must encompass a thorough history and physical examination, basic laboratories including liver chemistries, serum calcium and triglyceride levels, as well as an US and/or contrast-enhanced CT of the abdomen ( Fig.…”