What Is Sphincter of Oddi Dysfunction?

Medically Reviewed by Minesh Khatri, MD on February 22, 2024
4 min read

The sphincter of Oddi is a muscular valve that plays a vital role in digestion. It controls the flow of bile and pancreatic juice. It opens and closes to let the juices flow from the liver and pancreas into the small intestine

If the sphincter doesn’t open at the right time, it can lead to a backup of digestive juices (bile and pancreatic juice), resulting in severe abdominal pain.

Mild cases of sphincter of Oddi dysfunction can be treated with medications, but severe cases require a surgical procedure known as sphincterotomy.

Sphincter of Oddi dysfunction can be caused by scarring, spasm, strictures, or relaxation of the valve.

When this happens, the bile and pancreatic juice can't flow forward. This causes a backup of digestive juices that causes severe abdominal pain.

The sphincter of Oddi dysfunction symptoms can be mild or severe. They can also go away and appear suddenly.

Some common sphincter of Oddi dysfunction symptoms include:

  • Abdominal pain (can be severe or mild)
  • Diarrhea
  • Nausea
  • Vomiting
  • Chills
  • Fever

If you are a middle-aged woman without a gallbladder, visit your doctor as soon as you experience any of the symptoms.

You should also know about three categories of sphincter of Oddi dysfunction:

  • Type I - patients have pain as well as abnormal liver enzymes and a dilated common bile duct. 
  • Type II - symptoms consist of pain and only one objective finding, 
  • Type III - patients have biliary pain only. 

The doctors do several tests or ultrasounds in categories I and II to find clear evidence of the dysfunction. These include abnormal blood test results or dilated (widened) bile duct in the ultrasound report.

Category III shows no abnormalities in the test results or lab findings. The only evidence is abdominal pain. This category is way more challenging to diagnose. Some research also indicates that this symptom may be due to other health issues. It also doesn't respond to the sphincter of Oddi treatments.

The sphincter of Oddi dysfunction is mainly observed in women ages 30 to 50. Those who have had their gallbladders removed in surgery also have a higher risk of developing this condition.

The doctor starts the checkup by checking if the abdominal pain is due to any other condition or not. This checkup also helps him to identify any serious health issues you may have. Potential problems include pancreatic cancer, bile duct cancer, peptic ulcer disease, or stones in the bile ducts. 

In rare cases, some heart issues, including angina or ischemia, can also cause severe abdominal pain.

The doctor then examines your sphincter of Oddi to ensure its normal working. The procedure is called sphincter of Oddi manometry (SOM). 

Before the examination, you will be given medicine to relax. Then, the doctor will insert a small plastic tube near the sphincter of Oddi, either in the pancreatic or bile duct. This helps them see how well the valve is contracting and expanding. 

If you are in the category III sphincter of Oddi dysfunction, you may not be experiencing severe pain. In such cases, doctors opt for medical treatment and prescribe some medications. 

Most people get better with the use of pain medications, which stop the spasms in the sphincter of Oddi.

If your condition is in category I or II, where the pain is quite severe, your doctor may suggest an endoscopic procedure called endoscopic retrograde cholangiopancreatography (ERCP). 

During ERCP, the surgeon inserts an endoscope through the mouth into the duodenum. This is the area where the bile and pancreatic ducts drain. Then, doctors inject a dye into the ducts.

Some doctors also perform sphincterotomy with ERCP. For sphincterotomy, the doctor will sedate you or put you to sleep with anesthesia. When the process starts, they will insert a thin instrument into your small intestine to cut the sphincter of Oddi. 

The surgeon will also make sure that your gallbladder (if it's not removed) or bile ducts don't have any stones.

Sphincterotomy takes away a good part of the pain in most cases. After the procedure, you will feel relieved and may not experience other symptoms. Sphincterotomy is only performed, though, when the earlier medical treatment fails. 

The process poses a high risk of complications. About 5% to 15% of people experience complications, from mild inflammation in the pancreas to hemorrhage and perforation. In cases with severe complications, you may need to receive long-term medical care.