Sphincter of Oddi is an organ that regulates the passage of bile through the bile duct from the liver to the duodenum. Also, one of its functions is the regulation of the secretion of the gallbladder, as well as the entry of pancreatic enzyme into the intestine. On the bile duct, the activity of the gastrointestinal tract also greatly affects.
It is important that the organ functions properly.
If the work of CO (sphincter of Oddi) deviates from the norm, then the activity of the entire gastrointestinal tract begins to suffer. A patient who has this disorder experiences paroxysmal pain in the upper abdomen, liver enzymes may be elevated, an expansion in the common bile duct appears, increased secretion of pancreatin, and pancreatitis may develop in general. What is this - sphincter of Oddi? What is the danger of violations in the work of the body? So, first things first.
Sphincter 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 dysfunction is classified as a biliary tract disorder.
Anatomically, CO is a case of muscles and connective tissue that surrounds the connection of the pancreatic and bile ducts into one common vessel, which enters the wall of the duodenum. Based on the structure of the sphincter, three parts are distinguished from it - this is the segment of the bile duct, the segment of the duct of the pancreas and the sphincter of the ampoule that surrounds the common channel of these two organs.
In this ampoule, a constant pressure is maintained, which normally is 10-15 mmHg. This pressure is regulated by the smooth muscles that form the case and are located both longitudinally and circularly.
CO functions
What is it - the sphincter of Oddi in terms of functionality?
The three main ways this sphincter works is to regulate the flow of bile and pancreatic juice into the duodenum, prevent reflux (burping) of the contents of this intestine back into the gall-pancreatic duct, and also ensure the accumulation of hepatic bile in the gall bladder.
All these functions are possible due to the ability of OD to regulate pressure within itself and between the system of its ducts and the duodenum.
What is CO dysfunction?
Oddi sphincter dysfunction (DLS) is a partial disorder of patency of the above ducts. It has either an organic or functional nature, and its clinical manifestation is a violation of the outflow of pancreatic juice and bile.
Based on the nature of DLS, patients with this disorder are divided into two types - those to which it developed against the background of stenosis (spasm) of the sphincter and those who have revealed functional dyskinesia of this organ. Anatomical stenosis of CO is caused by inflammation and fibrosis (when muscle tissue is replaced by connective tissue, scars form), and possibly by sheath hyperplasia. Fibrosis and inflammation can be triggered by the passage of stones along the ducts or attacks of acute pancreatitis. Doctors agree that it is very difficult to distinguish between the organic and functional causes of this disorder, because they can be influenced by the same factors.
Very often there is dysfunction of the sphincter of Oddi in those who have undergone cholecystectomy. One of the components of the postcholecystectomy syndrome is precisely this disease, in fact, it usually provokes this syndrome. Most of these patients suffer from organ failure, which manifests itself as a constant entry of bile into the duodenum. Sometimes there is a spasm (dyskinesia) of the sphincter of Oddi. If the gall bladder has been removed, then even a slight decrease in CO results in increased pressure throughout the 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 as follows:
- the duration of the attacks is about half an hour or more, they are interspersed at intervals without pain, and then they can repeat again;
- seizures occur one or more times during the year;
- the pain is so severe that a person cannot endure it while engaging in any activity;
- the examination does not lead to the identification of any structural changes that explain these symptoms.
Tests can show one or more of the following symptoms: an increase in direct bilirubin and (or) pancreatic enzymes, alkaline photophase, serum transaminases.
Types of dysfunction of the sphincter of Oddi
In medicine, patients are classified into two categories - patients with disorders in the biliary segment of the sphincter (most of them) and patients with sphincter of Oddi dysfunction according to the pancreatic type (there are fewer ones).
The examinations that are needed to get the full picture are ERPC (endoscopic retrograde pancreatocholangiography) and sphincter manometry. These two methods are referred to as invasive examinations for this disease.
Examination of ERPC helps to exclude other ailments of the pancreas and bile ducts, which could cause similar pain symptoms. In addition, it allows you to determine both the size of the ducts and the periodicity 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 introducing a special catheter into the examined ducts. It also helps to understand what is the motor activity of CO.
Biliary types of DSO
Using these two methods, patients with DLS are divided into several groups. Oddi sphincter dysfunction according to biliary type No. 1, when the patient has bile colic, the total bile duct is dilated, slower than normal excretion of a special contrast agent is recorded, and the level of liver secretions is increased. Violations of this group are caused by stenosis of the sphincter of Oddi. Secondly, this is the sphincter of Oddi dysfunction according to biliary type No. 2. Here, patients experience biliary pain in combination with some symptoms characteristic of the first type. Their disorders can be both functional and structural. Thirdly, it is biliary type 3, accompanied by exclusively biliary seizures, which indicates the functional nature of the disease. And, finally, a subtype of pancreatic dysfunction of the sphincter of Oddi is distinguished. With him, the patient experiences a characteristic pancreatitis pain in the epigastric region, which can give back. Analyzes in such patients show elevated lipases and amylases. But since they have no objective reasons for pancreatitis (for example, addiction to alcohol, etc.), doctors establish a diagnosis of the uncertain etymology of recurrent pancreatitis.
Laboratory studies make sense only directly in pain attacks. Then the analysis will show an increase in certain enzymes, which will help to identify the causes and nature of this disease.
Non-invasive examination with DLS
What is this - sphincter of Oddi? The overall picture of the organ itself and its dysfunction is more or less clear. Next, we consider diagnostic methods for the study of DLS.
For non-invasive examination with this disease, ultrasound is used. It helps to determine the diameter of the desired ducts before and after the introduction of "provocative" substances. For example, to make an ultrasound successful in terms of diagnosis, the patient takes fatty foods. This stimulates the production of cholecystokinin and increased bile secretion. Diameters are measured over an hour with a frequency of 15 minutes. With the normal functioning of CO, the diameter remains practically unchanged or may slightly decrease, but with a disease it increases markedly. True, this method does not imply an extremely accurate diagnosis of dysfunction of the sphincter of Oddi to its subtypes.
There is also hepatobiliary scintigraphy, which allows you to track the time of penetration of a specially introduced isotope moving together with bile from the liver into the duodenum 12. If time is increased, then this is evidence of the presence of DLS.
Conservative treatment
It begins with a diet prescribed by the doctor. Drug therapy also refers to it, i.e. taking medication.
In a diet with DLS, the most important thing is a low fat content. In the diet, there must be fibers of plant origin or such food additives as bran, etc. However, all vegetables and fruits must be thermally processed, i.e. cooked or baked.
And the purpose of the drugs in the treatment of DLS is primarily symptomatic. For example, the removal of spasm of smooth muscles WITH. This is achieved through the appointment of antispasmodics. Also, drugs with anticholinergic properties are used for this.
Drug Overview
There are antispasmodics of the myotropic type, which reduce motor activity and smooth muscle tone: "Papaverine", "Bentsiklan", "Drotaverin". One of the most effective drugs, doctors consider Mebeverin, which directly affects smooth muscle. It is believed that it is on average 40 times more effective than Papaverine. Its concomitant properties are normalization of intestinal activity, i.e. it reduces hyperperistalsis, relieves spasm, but does not cause hypotension. Also good reviews are used by Odeston (Gimekron). It does not have anticoagulating properties and is an artificial analogue of the substance present in fennel and anise, which were previously used in medicine as antispasmodics. There were practically no cases of any side effects when taking this medication. Reduce pain and medications containing slow calcium channel blockers. These are Nifedipine, Veropamil, Diltiazem, etc. All of the above drugs have significant side effects, so they are prescribed with great care.
Invasive DLS treatments
If the symptoms of the disease are severe, then patients are recommended surgery. In the case of ineffective non-invasive treatment of the sphincter of Oddi, more precisely its dysfunction, and with suspected stenosis, there is a need for endoscopic papillosphincterotomy. 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 probability of success in the case of this intervention ranges from 7 to 55 percent. Therefore, in this case, this type of operation is used very rarely.
With endoscopic balloon dilatation, temporary catheters, the so-called stents, are implanted in CO. This operation is an alternative to the previous one. But the effectiveness of such an implantation for patients with DLS is still not proven. Now it is prescribed in very limited quantities. However, balloon dilatation is advisable for patients whose bile ducts are not dilated.
A relatively new method of invasive treatment is the introduction of botulinum toxin (Botox) into the duodenal nipple. 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 still exists at the stage of clinical study, it is also not yet widely used.
Conclusion
From the above material, it became clear what it is - the sphincter of Oddi, what is its dysfunction and ways of examining the latter.
As we saw, in most cases, diagnostic methods can correctly determine the nature of the pathology, and the presence of high-efficiency drugs in most cases improves the well-being of patients.