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

Have you had surgery to remove your gallbladder? Do you still have occasional severe pain in the upper right side of your abdomen? Is it like the pain you get from gallstones? Many people think that after having their gallbladder removed, their stomach pain is completely gone. But sometimes the cause of this pain is not what we think, but something else. That's what we're going to talk about today.

Simply put, what is the Sphincter of Oddi?

To understand this, let's first take a look at the digestive process in our body. It's a very complex, amazing thing. Many organs, such as our liver and pancreas, work together to convert the food we eat into energy.

• Liver: This is where the chemical called bile is produced. It is temporarily stored in the gallbladder.
• Pancreas: This gland produces enzymes that help digest food.

The bile from the liver and the enzymes from the pancreas must both flow together into our small intestine. The small muscle that controls that journey, which acts like a gate, is called the Sphincter of Oddi .

When working properly, this muscle, called the Sphincter of Oddi, opens at the right time, allowing bile and enzymes to pass into the small intestine. Then it closes again.

So what is Sphincter of Oddi Dysfunction (SOD)?

Simply put, Sphincter of Oddi Dysfunction is when that gate we talked about, the muscle called the Sphincter of Oddi, doesn't open properly when it should. What happens then? That bile and pancreatic enzymes can't get into the small intestine and get stuck in that tube. When it gets stuck like this, it causes severe stomach pain, similar to what happens when you have gallstones.

This condition is most often seen in people who have had their gallbladder removed (cholecystectomy). For this reason, it is sometimes called "post-cholecystectomy syndrome."

What are the main types and categories of this condition?

This condition can be divided into two main types and three categories. It is important to know this, because treatment depends on this type.

What are the symptoms of this disease?

The main and most common symptom of this condition is severe abdominal pain, similar to the pain experienced when gallstones form.

• Where the pain comes from: Burning pain starting in the upper right side of the abdomen.
• Spreading pain: Sometimes this pain can feel like it's going to the right shoulder or back.
• Duration of pain: The pain usually goes away after about 30 minutes to an hour. However, it can come back one day.

In addition to this main pain, several other symptoms may be observed:

• Nausea and vomiting
• Fever
• Chills
• Diarrhea

Why does this happen? What are the risk factors?

There is no single cause for this. Sometimes scarring or inflammation of the bile ducts can block the flow of bile. Other times, without any blockage, it can be caused by a problem with the sphincter of Oddi muscle itself.

But there are several groups that are at higher risk of this condition.

• Most common: Women between the ages of 20-50 who have had their gallbladder surgically removed.
• Other risk factors:
• People who have had weight loss surgery (Gastric bypass surgery).
• People who develop recurrent pancreatitis.
• People who had gallstones.
• People who have had a liver transplant.
• People with underactive thyroid (Hypothyroidism).
• People with Irritable Bowel Syndrome (IBS).
• People who drink alcohol excessively.
• People who use certain painkillers (especially opiates).

Can it be dangerous if left untreated?

This is not a life-threatening condition, and major complications are rare. However, the severe pain it causes can be a major obstacle to your ability to function normally.

But if it continues without treatment, the following conditions may rarely occur:

• Chronic pancreatitis: Irreversible damage to the pancreas caused by continued inflammation.
• Jaundice: A yellowing of the skin and whites of the eyes caused by the accumulation of bilirubin, a component of bile, in the body.

How does the doctor diagnose this disease?

If you have these symptoms, the first thing your doctor will do is check for other conditions that could be causing your stomach pain, because this type of pain can be caused by many other conditions.

For example, you need to make sure that there are no serious conditions like peptic ulcer disease, choledocholithiasis, or pancreatic or bile duct cancer. Surprisingly, the pain of some heart conditions (like angina) can also feel like stomach pain.

After ruling out all of these, your doctor may ask you to do these tests:

• Blood tests: Check for elevated liver and pancreatic enzyme levels.
• Imaging tests: To look for abnormalities in the sphincter of Oddi muscle or ducts. These may include abdominal ultrasound, CT scan, endoscopic ultrasound (EUS), upper endoscopy, and magnetic resonance cholangiopancreatography (MRCP).

Special test: ERCP with Manometry

Sometimes, if all of these tests are inconclusive, the doctor may refer you to a special test called Endoscopic Retrograde Cholangiopancreatography (ERCP) with manometry .

This involves going to the Sphincter of Oddi with the help of an endoscope, inserting a very small plastic tube, and measuring the pressure to see how well that muscle contracts and expands.

What are the treatments for this?

The treatment method depends on the severity of your symptoms and which category you are in.

1. If the pain is not too severe (especially for category III):

The doctor will prescribe you painkillers (non-opioid) and muscle relaxants.

2. If the pain is severe (for categories I and II):

If it is difficult to control with medication, the doctor may refer you to a treatment called ERCP with sphincterotomy . This is done under anesthesia or under anesthesia. The surgeon uses an endoscope to go to the Sphincter of Oddi, cut a small amount of the muscle that is stuck, and loosen it. At the same time, they check for stones in the bile ducts.

Risks of sphincterotomy treatment

This treatment helps reduce pain in most patients with categories I and II. However, it is also a complex procedure with some risks.

• About 10% - 15% of patients may develop complications such as pancreatitis.
• Although this inflammation is often mild, it can sometimes become severe and even life-threatening.
• In such cases, you may have to stay in the hospital for a long time for treatment.

Therefore, doctors only resort to this treatment if it cannot be controlled with other treatments.