Sphincter of Oddi Function and Risk Factors for Dysfunction

Elham Afghani, Simon K Lo, Paul S Covington, Brooks D Cash, Stephen J Pandol, Elham Afghani, Simon K Lo, Paul S Covington, Brooks D Cash, Stephen J Pandol

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.

Keywords: amylase; biliary colic; functional biliary disorder; hepatic enzymes; lipase; pancreatitis; sphincter of Oddi; sphincter of Oddi dysfunction.

Figures

Figure 1
Figure 1
Sphincter of Oddi (SO) and its anatomic relationships. In the majority of patients, pancreatic and biliary secretions enter the duodenum through the SO. The sphincter structure with overlying mucosa protruding into the duodenum is called the papilla of Vater. The image is an endoscopic photograph of the duodenum at this entry site. In addition, there are individual sphincters for both the common bile duct and the pancreatic duct proximal to the SO. All the sphincters are neurohumorally regulated. Adapted from Gorelick et al. (5). Used with permission. Copyright, American Gastroenterological Association Institute, Bethesda, MD, USA.

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Source: PubMed

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