Disorders of the sphincter of Oddi and chronic pancreatitis

Post by Master, Doctor Mai Vien Phuong - Gastrointestinal Endoscopy - Department of Medical Examination & Internal Medicine - Vinmec Central Park International General Hospital.

Sphincter of Oddi dysfunction (SOD is a term used to describe a heterogeneous group of pain syndromes caused by abnormalities in the sphincter's ability to contract. found a link between sphincter of Oddi disorder and chronic pancreatitis.However, it is not clear whether this is a cause-and-effect relationship.

Initial studies investigating the association of sphincter of Oddi disorder and chronic pancreatitis were inconclusive. Several studies showed no difference in pancreatic sphincter pressure between patients with chronic pancreatitis and controls. However, these studies involved patients with chronic alcoholic pancreatitis and in two controlled studies patients with unexplained abdominal pain or suspected biliary dyskinesia.
In addition, although one of these studies did not find a significant difference between basal sphincter of Oddi pressure in patients with chronic pancreatitis and controls, pancreatic ductal pressure in the early stages of pancreatitis chronic is significantly higher than in the general population. Other trials have shown a correlation between increased pancreatic sphincter pressure and chronic pancreatitis. Many of these also employ patients with chronic pancreatitis secondary to alcohol. However, in a single study that excluded alcoholic patients, pancreatic sphincter pressures in the early stages of chronic pancreatitis were significantly higher than in controls.

2. Evidence for an association between sphincter of Oddi dysfunction and chronic pancreatitis Laugier performed manometry of the sphincter of Oddi and main pancreatic duct before and after intravenous administration of secrettin in patients with pancreatitis. chronic and control group. Secretin resulted in a transient increase in pancreatic ductal pressure in controls, but chronic pancreatitis patients had persistently elevated pancreatic ductal pressure and a manometric pattern of sphincter of Oddi dysfunction. The increase in ductal pressure due to secretion is greater and more prolonged in patients with chronic pancreatitis, especially with recent onset (less than 4 years).
It has been shown that the local effect of alcohol on the sphincter of Oddi leads to increased sphincter pressure of Oddi, suggesting a role in the pathogenesis of alcoholic pancreatitis. Tarnasky et al looked for evidence of chronic pancreatitis in manometry patients to investigate unexplained upper abdominal pain (n = 104). Pancreatic ductography, EUS and measurement of bicarbonate concentration in pancreatic juice were performed. Patients with sphincter of Oddi dysfunction were 4 times more likely to develop chronic pancreatitis than patients with normal sphincter pressure (P = 0.01). Of 68 patients with sphincter of Oddi disorder, 20 (29%) had structural evidence of chronic pancreatitis and 20 of 23 patients (87%) with chronic pancreatitis had sphincter of Oddi dysfunction.
The authors concluded that sphincter of Oddi dysfunction was associated with structural evidence of chronic pancreatitis in patients with biliary pancreatitis of unknown etiology. Patients with chronic pancreatitis and sphincter of Oddi were significantly older than those with sphincter of Oddi but without chronic pancreatitis. This increases the likelihood that sphincter of Oddi dysfunction precedes the development of pancreatitis.
The available evidence strongly suggests a link between disorders of the sphincter of Oddi and chronic pancreatitis. However, it remains unclear whether this is a cause-and-effect relationship. Therefore, more work is needed to clarify this issue.

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