From the Research
Sphincter of Oddi dysfunction (SOD) is diagnosed through a combination of clinical evaluation, imaging studies, and specialized tests, with endoscopic retrograde cholangiopancreatography (ERCP) with manometry being the gold standard diagnostic test, as stated in the most recent study 1. The diagnosis of SOD involves several steps, including:
- Initial assessment of symptoms such as recurrent upper abdominal pain, elevated liver or pancreatic enzymes, and dilated bile or pancreatic ducts
- Noninvasive imaging like ultrasound, CT, or MRI/MRCP to rule out other causes of biliary obstruction such as stones or tumors
- If these are inconclusive but SOD is still suspected, ERCP with manometry is performed to measure baseline pressure, amplitude and frequency of phasic contractions, and response to stimulation
- A basal sphincter pressure exceeding 40 mmHg is considered diagnostic of SOD, as noted in 2 Some key points to consider in the diagnosis of SOD include:
- The Milwaukee classification system, which stratifies patients according to their clinical picture based on elevated liver enzymes, dilated common bile duct, and presence of abdominal pain, as discussed in 3
- The use of hepatobiliary scintigraphy and fatty meal sonography as alternative diagnostic methods, as mentioned in 1
- The importance of patient selection for ERCP with manometry, due to the risks of pancreatitis, as highlighted in 4 It's also important to note that the diagnosis and management of SOD can be complex and may require a multidisciplinary approach, as stated in 5.