From the Research
Functional biliary sphincter of Oddi disorder (SOD) according to Rome IV criteria is diagnosed based on specific clinical features, including biliary pain, absence of structural abnormalities, and elevated liver enzymes, as supported by the most recent study 1. The diagnosis requires the presence of biliary pain, absence of structural abnormalities that could explain the symptoms, and elevated liver enzymes (ALT, AST, or alkaline phosphatase) that are at least twice the upper limit of normal on two or more occasions.
- The pain must be episodic, located in the epigastrium or right upper quadrant, lasting 30 minutes or longer, and occurring at different intervals rather than daily.
- Additionally, the pain should be severe enough to interrupt daily activities or lead to emergency department visits, and it should not be relieved by bowel movements, postural changes, or antacids. Supportive criteria include:
- Abnormal biliary drainage as documented by scintigraphy
- Delayed emptying of the biliary tree on MRCP with secretin stimulation
- Abnormal sphincter of Oddi manometry showing elevated basal pressure These diagnostic criteria help differentiate functional biliary SOD from other conditions causing similar symptoms, such as gallstones or pancreatitis, as noted in 2 and 3. The pathophysiology involves dysfunction of the sphincter of Oddi muscle, leading to increased resistance to bile flow and subsequent pain and transient liver enzyme elevations, which is consistent with the findings in 4 and 5.