The Sphincter of Oddi is an organ that regulates the entry of bile through the biliary tract from the liver into the duodenum. Also, one of its functions is the regulation of the secretion of the gallbladder, as well as the flow of pancreatic enzyme into the intestine. The activity of the gastrointestinal tract also has a huge impact on the bile duct.
It is important for the organ to function properly
If the work of SO (sphincter of Oddi) deviates from the norm, then the activity of the entire gastrointestinal tract begins to suffer. A patient who develops this disorder experiences paroxysmal pain in the upper abdomen, liver enzymes may be elevated, there is dilation in the common bile duct, increased secretion of pancreatin, and pancreatitis may develop in general. What is the sphincter of Oddi? What are dangerous violations in the work of the body? So, first things first.
Sphincter of Oddi device
The causes of violations in the activities of this body can be of two types - structural or functional. According to the medical classification, this dysfunctionreferred to as a disorder of the biliary tract.
Anatomically, SO is a case of muscles and connective tissue that surrounds the junction of the pancreatic and bile ducts into one common vessel that enters the wall of the duodenum. Based on the structure of the sphincter, it has three parts - a segment of the bile duct, a segment of the pancreatic duct and the sphincter of the ampulla that surrounds the common channel of these two organs.
This ampoule maintains a constant pressure, which is normally 10-15 mmHg. This pressure is regulated by smooth muscles that form a sheath and are located both longitudinally and circularly.
CO Functions
What is the sphincter of Oddi in terms of functionality?
The three main ways this sphincter works are to regulate the flow of bile and pancreatic juice into the duodenum, to prevent reflux (belching) of the contents of this intestine back into the bile-pancreatic duct, and to ensure the accumulation of hepatic bile in the gallbladder.
All these functions are possible due to the ability of the OD to regulate the pressure inside itself and between its duct system and the duodenum.
What is CO dysfunction?
Sphincter of Oddi dysfunction (SSO) is a partial disorder of the patency of the ducts described above. It has either an organic or functional nature, and its clinical manifestation is a violation of the outflow of pancreatic juice and bile.
Because of the nature of DSO, patients with thisThe disorder is divided into two types - those to which it developed against the background of stenosis (spasm) of the sphincter and those who have functional dyskinesia of this organ. Anatomical stenosis of the SO is caused by inflammation and fibrosis (when the muscle tissue is replaced by connective tissue, scars form), and possibly by membrane hyperplasia. Fibrosis and inflammation can be triggered by the passage of stones through the ducts or attacks of acute pancreatitis. Doctors agree that it is very difficult to distinguish between organic and functional causes of this disorder, because they can be influenced by the same factors.
Sphincter of Oddi dysfunction is very common in those who have undergone cholecystectomy. One of the components of the postcholecystectomy syndrome is precisely this disease, in fact, it, as a rule, provokes this syndrome. Most of these patients suffer from a lack of organ functionality, which manifests itself as a constant ingress of bile into the duodenum. Sometimes spasm (dyskinesia) of the sphincter of Oddi is also noted. If the gallbladder has been removed, then even a slight reduction in CO2 results in increased pressure in the entire bile duct. This phenomenon is accompanied by pain.
How to diagnose?
Naturally, such a diagnosis should be made by a doctor. Below we list all the characteristic symptoms of the sphincter of Oddi, or rather its dysfunction.
First of all, it is a pronounced, persistent pain with localization in the center of the epigastrium and in the right upper abdomen. The nature of this pain is:
- duration of seizures - abouthalf an hour or more, they are interspersed with intervals without pain, and then they can repeat again;
- attacks occur one or more times throughout the year;
- the pain is so strong that a person cannot endure it while doing any activity;
- examination does not reveal any structural changes to explain these symptoms.
Tests may show one or more of the following: increased direct bilirubin and/or pancreatic enzymes, alkaline phosphatase, serum transaminases.
Types of dysfunction of the sphincter of Oddi
In medicine, patients are classified into two categories - these are patients with disorders in the biliary segment of the sphincter (most of them) and patients with dysfunction of the sphincter of Oddi of the pancreatic type (there are fewer).
The tests needed to get the full picture are ERCP (endoscopic retrograde cholangiopancreatography) and sphincter manometry. These two methods are referred to as invasive examinations for this disease.
Examination of ERCP helps to exclude other ailments of the pancreas and bile ducts that could cause similar pain symptoms. In addition, it allows you to determine both the size of the ducts and the frequency of their emptying.
And with the help of endoscopic manometry (which is considered the most reliable method for examining CO), the pressure in the sphincter is measured by inserting a special catheter intoexamined ducts. It also helps to understand what is the motor activity of CO.
Biliary types of DSO
Using these two methods, patients with SWD are divided into several groups. Dysfunction of the sphincter of Oddi according to biliary type No. 1, when the patient has biliary colic, the common bile duct is dilated, slower than normal excretion of a special contrast agent is recorded, and the level of hepatic secretions is increased. Violations of this group are due to stenosis of the sphincter of Oddi. Secondly, this is dysfunction of the sphincter of Oddi according to the biliary type No. 2. Here, patients experience biliary pain in combination with some of the symptoms characteristic of the first type. Their disorders can be both functional and structural. Thirdly, it is biliary type 3, accompanied exclusively by biliary attacks, which indicates the functional nature of the disease. Finally, a subtype of pancreatic dysfunction of the sphincter of Oddi is distinguished. With it, the patient experiences epigastric pain characteristic of pancreatitis, which can radiate to the back. Analyzes in such patients show elevated lipases and amylases. But since they do not have objective causes for pancreatitis (for example, addiction to alcohol, etc.), doctors make a diagnosis of an uncertain etymology of recurrent pancreatitis.
Laboratory studies make sense only directly in case of pain attacks. Then the analysis will show an increase in certain enzymes, which will help to identify the causes andthe nature of the disease.
Non-invasive examination for DSO
What is the sphincter of Oddi? The overall picture of the organ itself and its dysfunction is more or less clear. Next, consider the diagnostic methods for studying DSO.
Ultrasound is used for non-invasive examination in this disease. It helps to determine the diameter of the desired ducts before and after the introduction of "provocative" substances. For example, in order to make an ultrasound successful in terms of diagnosis, the patient eats fatty foods. This stimulates the production of cholecystokinin and increased bile secretion. Diameters are measured within an hour with a frequency of 15 minutes. During normal functioning of the CO, the diameter practically does not change or may decrease slightly, but with a disease it increases markedly. True, this method does not imply an extremely accurate diagnosis of Oddi's sphincter dysfunction to its subtypes.
There is also hepatobiliary scintigraphy, which allows you to track the time of penetration of a specially introduced isotope, moving along with bile from the liver into the duodenum. If the time is increased, then this is evidence of the presence of DSO.
Conservative treatment
It starts with a diet that the doctor prescribes to the patient. It also includes drug therapy, i.e. medication.
The most important thing in a diet with DSO is a low fat content. The diet should contain vegetable fibers or nutritional supplements such as bran, etc. However, all vegetables and fruits shouldbe thermally processed, i.e. boiled or baked.
And the purpose of drugs in the treatment of DSO is primarily symptomatic. For example, the removal of spasm of smooth muscles of SO. This is achieved through the appointment of antispasmodics. Also, drugs with anticholinergic properties are used for this.
Drugs at a glance
There are antispasmodics of the myotropic type that reduce motor activity and smooth muscle tone: "Papaverine", "Benciclane", "Drotaverine". Doctors consider Mebeverin to be one of the most effective drugs, which directly affects smooth muscles. It is believed that it is on average 40 times more effective than Papaverine. Its concomitant properties are the normalization of intestinal activity, i.e. it reduces hyperperistalsis, relieves spasm, but does not cause hypotension. Odeston (Gimekron) also enjoys good reviews. It does not have anticoagulant properties and is an artificial analogue of the substance present in fennel and anise, which were previously used in medicine as antispasmodics. There are practically no cases of any side effects when taking this medicine. Reduce pain and drugs containing blockers of slow calcium channels. These are Nifedipine, Veropamil, Diltiazem, etc. All of the above drugs have significant side effects, so they are prescribed with great care.
Invasive treatments for DSO
If the symptoms of the disease are severe, then patients are recommended surgery. In case of ineffectiveness of non-invasive treatment of the sphincter of Oddi, or rather its dysfunction, and if stenosis is suspected, endoscopic papillosphincterotomy becomes necessary. If this is a patient of the first biliary type, then the success of the operation is likely in more than 90 percent of cases. The same level is maintained for patients of the second biliary type of sphincter of Oddi dysfunction with increased pressure in the organ itself. But with the third biliary type, the success rate in the case of this intervention ranges from 7 to 55 percent. Therefore, in this case, this type of operation is used very rarely.
In endoscopic balloon dilatation, temporary catheters, the so-called stents, are implanted into the SO. This operation is an alternative to the previous one. But the effectiveness of such implantation for patients with DSO has not yet been proven. Now it is prescribed in very limited quantities. However, balloon dilatation is reasonable in patients whose bile ducts are not dilated.
A relatively new method of invasive treatment is the introduction of botulinum toxin (Botox) into the duodenal papilla. The effect of this injection lasts from three to nine months. Its effect is to reduce the tone of the sphincter of Oddi. But since the method is still at the stage of clinical study, it is also not widely used yet.
Conclusion
Fromthe above material, it became clear what it is - the sphincter of Oddi, what is its dysfunction and the ways of examining the latter.
As we have seen, in most cases, diagnostic methods make it possible to correctly establish the nature of the pathology, and the presence of highly effective drugs in most cases improves the well-being of patients.
