Sphincter of Oddi! Anyone w/ the condition please chime in.

If you have or are suspected to have this condition (especially after RNY) please give me some info on what your treatment plan has looked like.  What do you do to relieve the pain?  Are you on any medication?

Need experienced input.

Never heard of it...can you explain what it is and/or symptoms?

The sphincter of oddi is a part of the body.  Is it not functioning  or spasming?

It has to do with the biliary system....the system that includes your gallbladder.  Sometimes, someone has pain that is suspected to be gallbladder, the gallbladder is removed and the pain remains.  It is fairly rare, but the spincter can be malfunctioning.  They test it similar to an ERCP or endoscopy with a small pressure sensative monitor that reads the pressure in the spincter.  I think there are some meds that can help with the pain and spasms as well as surgical intervention.  With the surgery, they nick the spincter, causing the seal to not be so tight.  There are not a lot of places that test for it, nor treat it.  The biggest thing with the surgery is the risk of peritonitis.

Everything I've read about it, the treatment options, surgery, meds, etc.... just leads me to feel like my method of pain control only is as good as those options, and possibly better.

Nice description though! 

I'm self-diagnosed sphincter of oddi disfunction. Do I REALLY have that? I'd need surgery to confirm it. The "attacks" were more frequent pre-WLS, same EXACT symptoms as GB attacks, but no GB left. Referred pain to right shoulder blade, and in extreme cases the referred pain would go to my right jaw, and even my right cheekbone. Since nobody seems willing to give me a solid diagnosis, because I'm never having the pain when I see the doc (except once, and they didnt' want to figure it out either).

So..... self diagnosed. My plan is to (1) Avoid high-cholesterol foods... I find that pizza is one of the biggest triggers. Not always... perhaps one in five pizza indulgences results in The PAIN.

So I keep stuff that could trigger an episode to a minimum.

But it still happens. Sometimes I go months (one or two) without an episode. Sometimes I get several in a month. It's PAINFUL.... I always make sure I have narcotics around. I never refuse them when docs offer them up for this or that pain, even though I use them less frequently than directed. When I feel an episode, I pop the strongest pain reliever I have and cross my fingers. Usually it damps the pain, and whatever is getting stopped up in a disfunctional duct (or sphincter?) gets passed. I keep a close eye on my symptoms though, and if it ever fails to go away, I'll go to the ER (I did once, but they thought it was a heart attack, adn then shrugged adn said no heart-attack, no biggee, and they sent me home). But I am careful and concerned each time, as it could be a precursor to a really big problem is stuff gets stopped up and doesn't unstop itself up. So far so good.

In the nearly 10 years since my GB was removed, the longest "attack" I ever had was the time it lasted three hours and I ended up in the ER. most times I take a pain pill, relax, and the pain passes. Noticeably passes.

I know that there aer ways for them to diagnose it (surgically if post-RNY) and they sometimes do a sphincter-ectomy... which worries me.

Lady...

I've always been a believer in natural remedies over and against pharmaceuticals.  That's how I sought out the gallbladderattack.com site.  I've been reading lots of information on that site and others and based on what I've read it seems that lemon and citrus peels are a good remedy for this type of issue.  I used to do lemon water regimines morning and night but stopped.  Any health conscious- holistic person will tell you that hot lemon water in the am and pm is great for digestion and liver cleansing.  The gallbladder site has two suggested products and I'm going to invest in them but I'm purchasing at my local healthfood store rather than the site.

1) D-Limonene -- you can read about Limonene on the gallbladder site and others and the information is consistently positive for the symptoms we get and also HEARTBURN and a mirad of other conditions. 

2) Lemon Tea -- read about the tea on the gallbladder site...but I wouldn't buy it there.  It's overpriced IMO.  A local healthfood store should have a comparable lemon tea product with the same ingredients as this one (at least a few of the ingredients).  The key is the lemon.  There are also liver cleansing teas that do the same thing that are less expensive in which you can add fresh organic lemon juice.

I tried to email you this information but your settings must prohibit contacting you.  If you could friend me it would be good so that we can K.I.T. and I'll let you know of my progress too.

Thanks to everyone *****sponded....and the woman who gave a GREAT description of the disorder. 

Like Lady Lithia I have the same symptoms and occurrence.  It is greatly increased when I eat fatty foods, but perhaps the cholesterol factor may be something I really need to watch.  I too am 'self diagnosing'  and self medicating.  I don't take the pain meds for the symptoms yet, although I will be talking to my doctor about giving me a stash for episodes.  Early on, I didn't realize that pain meds could help after the gallbladder was removed.  The fact that they do tells me that it is related to that muscle rather than being some time of indigestion.  I was once prescribed Vicodin and couldn't believe how fast the pain disappeared.  My pain has only lasted about 20min....but that's too much pain in my book!  Lithia....I'm glad you posted about the pain in the jaw.  I've been experiencing that too...radition to the jaw was making think neurological but I realized that it had to be connected the SOD b/c of timing.

I too am concerned about surgical intervention b/c of the possibility of scarring and causing the symptoms to recurr and be even worse.  I have been taking papaya enzymes everytime I eat and even when I feel the onset of an attack.  I have been getting that gnawing feeling that begins with just a little discomfort for no reason at all - having eaten nothing-- and I'll pop the enzymes even then.  Since the problem is digestive, I'm going to be looking into something that may help to keep the bile from clogging up and the Sphinter from being tense.

There is a website that I began reading about holistic remedies called gallbladderattack.com

If I'm not mistaken they have a regimine that one can follow to minimize the reccurrence of SOD incidents and it's natural.

I haven't had weight loss surgery yet but I do have SOD - I was diagnosed about a year after having by gallbladder removed. The pain is a lot like having a gallbladder attack and for me can actually progress to the point of pancreatitis-like pain (yuck) which means a trip to the ER.

I did have an ERCP with spinchterectomy several years ago. That helped a lot. My GI also prescribed a low dose of elavil - which really, really helps me reduce the incidence SOD attacks. One of my biggest concerns about getting RNY (or any weight loss surgery) is that with the SOD right upper quadrant pain is sort of par for the course for me so it'll be difficult for me to distingush when/if it's a SOD attack or related to complications from WLS. Good luck - I know how frustrating this condition can be.

Sphincter of Oddi Disease (Disorder) cab happen to people whom have had Gastric Bypass, especially RNY and also Gall Bladder removal. Symptoms are often severe constipation or cramping, severe pancreatitis (After Hopsitals have done MRI's to make sure you have no stones:

"

The sphincter of Oddi is a muscular valve that controls the flow of digestive juices (bile and pancreatic juice) through ducts from the liver and pancreas into the first part of the small intestine (duodenum). Sphincter of Oddi dysfunction (SOD) describes the situation when the sphincter does not relax at the appropriate time (due to scarring or spasm). The back-up of juices causes episodes of severe abdominal pain.

 

Doctor-Patient Communication

Doctors often consider SOD in patients who experience recurrent attacks of pain after surgical removal of the gallbladder (cholecystectomy). More than half a million of these surgeries are performed annually in the United States, and 10-20% of these patients present afterwards with continuing or recurrent pains. SOD is also considered in some patients who suffer from recurrent attacks of unexplained inflammation of the pancreas (pancreatitis).

About half of these patients will have findings on laboratory studies or imaging (blood test, ultrasound, CT scan, or MRCP) to suggest a definite abnormality, such as a stone in the bile duct. MRCP (magnetic resonance cholangiopancreatography) is nowadays a good non-invasive test for checking on the biliary and pancreatic drainage systems.

Based on patients histories, physical examinations, and other clinical data, doctors can categorize these patients as having SOD Types I and II. The categories help guide treatment of the disease. They are based on a system called the Milwaukee criteria.

Treatment

When symptoms are severe, standard treatment is to perform an endoscopic procedure called ERCP (endoscopic retrograde cholangiopancreatography). ERCP is a procedure for the examination or treatment of the bile duct and pancreatic duct. The procedure carries a risk of serious complications and is done under sedation by experts trained in the technique. It combines the use of x-rays and an endoscope that is passed down to the duodenum, where the bile duct and pancreatic ducts drain, and a dye that is injected into the ducts.

An additional procedure, sphincter of Oddi manometry (SOM), involves passing a catheter into the bile and/or pancreatic duct during ERCP to measure the pressure of the biliary and/or pancreatic sphincter. It is considered the gold standard diagnostic modality for SOD.

Treatment depends on what is found. It may often involve cutting the muscular sphincter (sphincterotomy) to remove any stones or to relieve any scarring or spasm of the sphincter.

As noted above, a very important problem in this context is that these ERCP procedures carry a significant risk of complications. In particular, ERCP (with or without sphincter of Oddi manometry) can cause an attack of pancreatitis in 5-10% of cases. While most of these result in a few days in the hospital, about 1% of patients suffer a major attack, with weeks or months in the hospital. Sphincterotomy also carries a small risk of other severe complications such as bleeding and perforation, and the possibility of delayed narrowing of a duct (stenosis) due to scarring.".

 

Because I had RNY and Gall Bladder removal, I have a 28Frg Feeding tube in my Remnant stomach so they (the doctors) can get to my duodenum. They are planning to do a Sphincterotomy and cut the muscles to my bile ducts, especially to my liver and Pancreas since they never work as they should. THANKFULLY, S.O.D, is pretty rare, and even rarer for a post RNY/Gastric Bypass patient.  There is no "guarantee" that the S.O.D treatment will work, however without it you get really messed up problems (I had way off the  chart Liver AST/ALT/Ammonia problems) very high Lipase and Pancrease problems and horrible severe pain.  I have NO stones in any of my bile ducts, but my remnant stomach was filled with air, fluid and a lot of backed up food. It took the doctors quite awhile to figure out what was wrong with me, including several liver biopsies (that were negative).  I go in the 19th of this month to get a sphincterotomy because my doctor said stents can cause more problems in people with RNY/Bypass surgery, and also RNY people are very hard to access as our duodenum is not easy to get to. It is a hard surgery with for (us) a lot of problems/recovery time and going back to eating no food and/or clear liquid if tolerated for up to a week or so plus a lot of pain killers.  I am only hoping this surgery will finally help heal my hepatic encephalitis, Sphincter of Oddi Disease can be one of the hardest to diagnose especially in people who are post op Gastric Bypass (Especially Roux-En-Y or D&S). My Bariatric Surgeon and the Doctor who is performing the Sphincterotomy say that RNY/D&S people often have a  closer to 50% Pancreatitis after the treatment.

 

I've had the large feeding tube inside my stomach for over a month and will have it for about another month approximately.  I hope this helps someone. While it is rare, it can happen to us, especially if you've had your gallbladder removed and had an RNY or D/S.

Best wishes for all.

Warmly,

Jackie E.