From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
The initial treatment approach for sphincter of Oddi dysfunction should prioritize medical therapy with smooth muscle relaxants, such as anticholinergics or antispasmodics, and lifestyle modifications, with endoscopic interventions like sphincterotomy considered if medical therapy fails, as supported by the most recent and highest quality study available 1.
Key Considerations
- Medical therapy should include smooth muscle relaxants, such as hyoscyamine (0.125-0.25 mg every 6 hours) or dicyclomine (10-20 mg three to four times daily), to help relax the sphincter.
- Nitrates and calcium channel blockers like nifedipine (10-20 mg three times daily) may also be used to relax the sphincter.
- Pain management is often necessary, with non-narcotic analgesics preferred due to the potential for opioids to worsen sphincter spasm.
- Lifestyle modifications are crucial, including a low-fat diet (less than 50g of fat per day), small frequent meals, and avoiding alcohol and smoking.
Rationale
The approach is based on the understanding that sphincter of Oddi dysfunction involves hypertonicity or dyskinesia of the sphincter, causing pain and potentially elevated liver or pancreatic enzymes. The most recent study 1 suggests that endoscopic and surgical treatment of SOD had similar morbidity and mortality, but treatment success and duration of remission were higher in those treated with surgery. However, given the invasive nature of surgical interventions, a stepped approach starting with medical therapy and lifestyle modifications is recommended, reserving endoscopic interventions for cases where medical therapy fails.
Evidence Support
- A study from 2019 1 found that surgical treatment of SOD had a higher success rate and longer duration of remission compared to endoscopic treatment.
- Another study from 2011 2 reported that endoscopic sphincterotomy provided complete relief of pain in 90.5% of patients with type I SOD, but the response rate decreased for type II and III SOD.
- The 2012 systematic review 3 concluded that manometry is the current gold standard for diagnosing SOD, but non-invasive investigations lack sufficient sensitivity and specificity for routine use.