Publication Type(s): Journal: Conference Abstract
Author(s): Bhandare A.; Kadir S.
Abstract:Introduction: Spinchter of oddi dysfunction( SODD) is a syndrome of non calculous obstruction of the flow of bile and pancreatic juices causing pain, abnormal LFTs and pancreatitis.The cause of SOD dysfunction is not clearly understood.We looked at our data of patients who had biliary manometry from 2004-2012 in a tertiary Hepatobiliary centre to analyse if we could accurately predict the diagnosis of SOD dysfunction based on history and non invasive.
Methods: We did a Retrospective analysis of all the patients who had biliary manometry between 2004 to 2012 and were confirmed to have Spinchter of odds dysfunction on measurements of pressures . Data was identified by GI physiology department and a total of 37 patients were included. Results: Most of the patients in our data were of younger age with mean age of 46.As show in previous studies, majority (n=35/36) were female.The duration of the symptoms varied with most (n=16) having symptoms longer than 5 years.Almost all of them (n=28) had cholecystectomy in the past.
Twenty Five Patients were non smoker with all of them denying alcohol abuse of more 18 units per week.Only 8 patients had previous history of mental health disorders.Surprisingly almost all of them had previous episode of pancreatitis and were diabetic.Almost half were on chronic opiates even prior to the diagnosis of SOD dysfunction. With regards to the LFTs none of them had remarkably abnormal liver function test but all of them had gallstones.47% had confirmed biliary dilatation on imaging. Conclusion: In our cohort of patients most of the patients with confirmed SOD dysfunction on manometry had history of gallstone disease presumably causing pancreatitis and leading to cholecystectomy.
We found a high prevalence of diabetes in these patients although we did not look into if they had developed chronic pancreatitis leading to diabetes.The prevalence of opiate use was also quite high which is a known cause of dilated CBD in itself. SOD dysfunction is not an uncommon condition in clinical practice and although its classified in the ROME III criteria of functional syndrome, it does lead to significant comorbidity and in some cases leads to unnecessary cholecystectomy. Furthermore biliary manometry and subsequently ERCP leads to a higher percentage of people developing pancreatitis.We were unable to identify a working equation to accurately predict the diagnosis of SOD dysfunction based on non invasive investigations.