Sphincter of Oddi Function and Risk Factors for Dysfunction

Abstract

The sphincter of Oddi (SO) is a smooth muscle valve regulating the flow of biliary and pancreatic secretions into the duodenum, initially described in 1887 by the Italian anatomist, Ruggero Oddi. SO dysfunction (SOD) is a broad term referring to numerous biliary, pancreatic, and hepatic disorders resulting from spasms, strictures, and relaxation of this valve at inappropriate times. This review brings attention to various factors that may increase the risk of SOD, including but not limited to: cholecystectomy, opiates, and alcohol. Lack of proper recognition and treatment of SOD may be associated with clinical events, including pancreatitis and biliary symptoms with hepatic enzyme elevation. Pharmacologic and non-pharmacologic approaches are discussed to help recognize, prevent, and treat SOD. Future studies are needed to assess the treatment benefit of agents such as calcium-channel blockers, glyceryl trinitrate, or tricyclic antidepressants in patients with SOD.

Codeine-Induced Pancreatitis in a Patient with Previous Cholecystectomy

“…Biliary segment involvement presents with biliary-type epigastric or right upper quadrant pain that mimics biliary colic but is not postprandial [6]. Pancreatic segment involvement produces acute pancreatitis [6]. It is likely that the patient described in this case had involvement of both segments of the sphincter of Oddi or the distal part of the sphincter surrounding the ampulla of Vater.…”

“…Spasm may involve the biliary segment of the sphincter (surrounding the distal common bile duct), pancreatic segment of the sphincter (surrounding the distal pancreatic duct) or both [6]. Biliary segment involvement presents with biliary-type epigastric or right upper quadrant pain that mimics biliary colic but is not postprandial [6]. Pancreatic segment involvement produces acute pancreatitis [6].…”

The place of eluxadoline in the management of irritable bowel syndrome with diarrhea

“…19 µ-opioid-receptor agonism increases the amplitude and frequency of SO phasic wave contractions while non-µ-opioid receptors mediate SO basal pressures. For unknown reasons, these effects appear to be accentuated in the absence of a gallbladder.…”

Surgical treatments for patients with recurrent bile duct stones and Oddis sphincter laxity

“…The sphincter of Oddi relaxes while gallbladder contracts, the bile is discharged into the duodenum (34,35). Neural and hormonal regulation of Sphincter of Oddi loses work when there is Oddis sphincter laxity, the basal pressue of biliary tract decreases, then resulting in gallbladder excessive filling and possible decreased discharge of bile flow into duodenum, and subsequently biliary tract cholestasis develops.…”