Do you still have stomach pain after gallbladder removal? This could be due to Sphincter of Oddi Dysfunction!

You may have been suffering from stomach pain for a long time due to gallstones. When you finally had surgery to remove your gallbladder, you probably thought you were completely free from this pain. But what if you still have the same severe stomach pain after the operation? It's really annoying. Many people face this kind of experience. So today we are going to talk about a condition that can cause this strange stomach pain even after the gallbladder is removed. That is Sphincter of Oddi Dysfunction .

Simply put, what is Sphincter of Oddi Dysfunction?

To understand this, let's first take a look at the process of our digestion. It's very simple. When we eat food, our bodies produce two special juices that help digest it.

1. Bile: This is made by the liver. It is stored in the gallbladder. It helps in the digestion of fats.

2. Pancreatic juice: This is made by the pancreas. The enzymes in it help digest proteins and carbohydrates in food.

Both of these juices travel to our small intestine, where they combine with food to complete the digestion process.

Now here's the important thing. Where these two juices enter the small intestine, there's a little piece of meat that's like a gate . It's like a valve. This is what we call the Sphincter of Oddi . Normally, when you need to digest food, this gate opens, the juices go in, and then it closes again.

Sphincter of Oddi Dysfunction is when this gate doesn't work properly. That is, this piece of meat doesn't open when it should and becomes tight. Then the bile from the liver and the juice from the pancreas can't get through to the small intestine and gets stuck. It's like a traffic jam. When the juice gets stuck like this, the pressure along the roads that those juices come from increases, causing severe stomach cramps.

This condition is often seen in people who have had their gallbladder surgically removed. Therefore, it is sometimes called post-cholecystectomy syndrome .

What are the main types of this condition?

Sphincter of Oddi Dysfunction can affect you in two main ways.

• Biliary Dyskinesia: This is a condition in which the bile ducts become blocked. The problem is in the way the bile flows.
• Pancreatitis: This is when pancreatic juice becomes blocked, causing the pancreas to swell and become inflamed.

Additionally, doctors divide the disease into three categories (Categories I, II, and III). This is very important because treatment is determined based on this category.

What are the main symptoms of this disease?

The main and most common symptom is severe abdominal pain, which is similar to the pain experienced with gallstones.

• The pain starts in the upper right side of the abdomen.
• Sometimes this pain also travels to the right shoulder or back .
• The pain is not constant. It goes away on its own after about 30 minutes or an hour. Then it can come back again in a day or a week.
• Some days the pain is mild, while other days it can be unbearable.

In addition to this main pain, the following symptoms may also occur:

• Nausea and vomiting
• Fever and chills
• Diarrhea

Who is at higher risk for this condition?

The exact cause of this has not yet been found, but certain factors increase the risk of this condition.

How is the disease diagnosed?

If your doctor suspects this after hearing about your symptoms, the first thing he or she will do is make sure that there is no other serious cause for your stomach pain. This is because other conditions such as stomach ulcers (peptic ulcers), gallstones, and pancreatic or bile duct cancer can also cause similar symptoms. Sometimes, heart disease (angina) pain can also feel like stomach pain.

After confirming that these things are not present, the following tests can be done to check for Sphincter of Oddi Dysfunction:

• Blood tests: Check for elevated liver and pancreatic enzyme levels.
• Scans: Scans such as abdominal ultrasound, CT scan, and MRCP are used to check if the bile duct or pancreatic duct is swollen/dilated.
• Endoscopy: A tube with a camera is inserted through the mouth to examine the stomach and small intestine.

ERCP test

In some cases, especially if type I or II is suspected, a special test called ERCP (Endoscopic Retrograde Cholangiopancreatography) is performed. In this, a camera tube is inserted, similar to an endoscope, into the sphincter of Oddi, and a small tube is inserted to measure the pressure in that muscle (manometry). This can then determine exactly whether it is opening or closing properly.

How is it treated?

Treatment options depend on what type (category) of Sphincter of Oddi Dysfunction you have.

• For Category III: This is difficult to diagnose, so surgery is usually not recommended. The doctor will prescribe painkillers and spasm-relieving medicines to control the pain.
• For Category I & II: If the pain is severe and difficult to control with medication, your doctor may suggest a treatment called sphincterotomy along with ERCP .

What is this Sphincterotomy?

This involves cutting a small piece of tissue called the Sphincter of Oddi with a small instrument that is passed through the camera tube during the ERCP examination. Then, the tight opening is permanently opened. Then, the digestive juices flow into the small intestine without any obstruction. This almost completely eliminates the pain.

But this is also a treatment that carries some risk. There is also a risk of pancreatitis. Therefore, this treatment is resorted to when other treatments have not yielded successful results.