Criteria for dysfunction of the sphincter of Oddi - all of the following:
(1) episodes of severe, steady pain in the epigastrium and right upper quadrant
(2) episodes last >= 30 minutes
(3) >= 1 episodes of symptoms during the previous 12 months
(4) pain is severe enough to interrupt daily activities and to prompt a visit to a physician
(5) no evidence of a structural abnormality is found
(6) no evidence of abnormal gallbladder emptying (dyskinesias) is present
Patients fall into 3 main groups:
(1) biliary type - biliary tract symptoms and laboratory test findings (abnormal liver function tests, elevated bilirubin) but negative evaluation for structural or functional disorders
(2) pancreatic type - pancreatitis-like symptoms with elevations of amylase and lipase
(3) mixed
The episodes of pain may:
(1) be accompanied by nausea and vomiting
(2) be associated with pain radiating to the back
(3) be associated with pain radiating to the right interscapular region (biliary-type)
(4) be partially relieved by bending forward (pancreatic type)
(5) be precipitated by meals
(6) awaken the patient at night
Often the diagnosis may not be considered until:
(1) a patient presents with persistent biliary tract complaints after removal of the gallbladder.
(2) a patient presents with persistent pancreatitis in the absence of common causes (no alcohol abuse, no stones, absence of hyperchylomicronemia, no implicated drugs)
Evaluations to consider:
(1) liver function tests and pancreatic enzymes during and after an attack
(2) ultrasonography of the gallbladder and biliary tract
(3) CCK-cholescintigraphy
(4) ERCP with manometry to evaluate pressures at the sphincter of Oddi
(5) microscopic evaluation of bile collected at the Ampulla of Vater
The extent of the workup depends on the severity of the condition. An invasive investigation may be appropriate for a person with severe or frequent symptoms or with attacks accompanied by significant abnormalities in liver function tests.
