# Sphincter of Oddi or Bile Duct Spasms



## genny (Jan 15, 2001)

Thanks Flux for the suggestions. I looked these up and here's what I found. I hope it may be of help to someone on the board. It's very interesting. It's kind of long.I have had my gallbladder out so why am I still having gallbladder pain? Biliary spasms affect from 2 to 10% of people who have had their gallbladders removed. A few people have it with intact gallbladders. It is more common among women then men. However, the causes of this syndrome are still unclear. It is generally considered a functional distorder that has a psychological component (somatization) and may increase under stress. The condition has symptoms of gallbladder disease pain and can start from a few weeks to years after the gallbladder has been removed. Burning pain in the epigastric (upper stomach) area radiates around to the back or under right shoulder blade. It often begins about a half hour after eating and can last for several hours. There can also be cramping under the shoulder blade or back and the stool (bowel movement) can be light tan if the normal amount of bile is not going into the intestine. These spasms and burning sensations are thought to be caused by contractions of the common bile duct (the duct that allows bile from the liver into the small intestine) or a tightening of the Sphincter of Oddi (the muscle opening that controls the flow of bile and pancreatic enzymes into the small intestine). Sometimes "gallstones" can form in the duct that may not be visible on Ultra Sound that will produce these symptoms. What is the medical treatment for this syndrome? Although this syndrome is likely related to stress, surgery is often recommended to eliminate the spasms if anti-spasmotics, nitrates, and calcium channel blockers are not effective. The procedure to diagnose and to treat this condition is called ERCP. In this medical procedure, a flexible endoscopic tube is gently inserted down the esophagus, through the stomach and into the small intestine. A small plastic tube from an opening in the end of the scope, is then placed in the Sphincter of Oddi and a solution is injected into the duct to measure the pressure (billiary manometry). If the pressure in this sphincter is high (above 40 mmHg) and/or "gallstones" are found in the duct, a surgical procedure sphincterotomy (cutting into the sphincter) to allow fluid and stones to flow out may be made. Stones can sometimes just be scooped out. However, ERCP sphincterotomy surgery can have acute and long term effects. In women who do not have stones in the common bile duct or high pressure, the surgery is less likely to be effective in reducing pain and spasms. From 20 to 40 percent of women who do not have bile stones, but have biliary pain symptoms, have acute pancreatitis following the cutting of the sphincter; up to 20% can have pancreatitis just from the procedure. There can be long term effects also. The common bile duct may become chronically inflamed due to reflux of small intestinal fluid into the duct. From 14-36 percent may have some long term complications which may result in chronic pain. If the common bile duct becomes plugged with stones or if the sphincter does not open to release the bile and pancreatic enzymes into the small intestine, serious medical problems can result. This includes jaundice from the back up of bile and pancreatitis from the back up of pancreatic enzymes. When this happens emergency ERCP or other surgery often needs to be done. What are the types of this dysfunction? Based on biliary manometry the dysfunction has been classified into three types. Type I and Type II have a combination of high pressure in the common bile duct, abnormal liver and/or pancreatic function tests, stones or "sludge" in the duct, recurring pancretitis, or other physical and chemical changes along with pain. Type I has high pressure and many of these other problems; Type II has several of these problems. Type III typically has pain only, without any of the other problems. ERCP is most generally effective when the pressure in the duct is high. ERCP is generally not very effective for Type III, so learning to manage it and knowing what triggers it is important. If I change my lifestyle can I reduce these spasms and pain? If ERCP and possible surgery have been suggested and it is considered elective, and not emergency, there are some lifestyle changes that may help to reduce and control the pain, burning, and spasms from this syndrome. Surgery should not be rushed into until all else fails. Please remember, however, you first need to go to a physician to determine the cause of these symptoms. The following lifestyle changes may be helpful in reducing the symptoms. Keep in mind that there are only limited references for some of the dietary remedies in the medical literature related to this syndrome. Reducing fat in the diet and other dietary changes Some research suggests that a diet high in fat and/or cholesterol may result in the formation of "gallstones" in the gallbladder or common bile duct. Measures to reduce diatary fat, triglycerides, and total cholesterol levels may be helpful in preventing stone formation. Several methods to accomplish this follow: Drink a tablespoon of bran mixed with a teaspoon of psyllium in a glass of water or juice upon arising (This mixture may help to absorb bile and prevent cholesterol and triglycerides from being re-absorbed back into the body thus lowering the cholesterol level). Eat a very low fat diet such as the Dean Ornish diet. This is primarily a vegitarian diet that has been successful in reversing heart disease Eat and cook with foods that contain very little fat and eliminate fatty foods from the diet. Enjoy no-fat sour cream, yogurt, cream and cottage cheese, milk, "egg beaters," or soy products. Eliminate all visible fat including butter, table spreads, etc. Eliminate chocolate, peanut butter, nuts, etc. To obtain some fat-soluble vitamins in the diet take 200 units vitamin E, an omega-3 fish oil capsule, and in cooking use a small amount of olive or canola oil Trim the skin and fat off of all poultry and meat.Drink plenty of fluids Some research suggests that drinking lots of fluids may help dilute the bile and prevent the formation of stones Drink at least 8 glasses of fluid a day Drink a half glass of soda-water (club soda) three times a day (a few research reports show this may be helpful in preventing stone formation) Drink one or two cups of green tea (acts as an antioxident) or herbal tea or aloe vera (may sooth the GI tract). Foods and Drinks to Avoid Experience will often show what foods need to be avoided to help prevent attacks. Experiment with different fruits and vegtables. There are some general rules of foods to eliminate from the diet because they contain a high amount fat or because they may cause irritation resulting in the contraction of the sphicnter or duct. Avoid spicy foods, onions, garlic and cucumbers. Avoid red wine, other alcoholic beverages, coffee, strong black tea and soda pop with caffeine. Avoid very cold drinks and foods. Lots of ice water, juice, soda pop and ice cream can sometimes cause spasms. Foods to eat Eat a well balanced diet containing the following Four(4) servings of fruits (apples and pears may be less likely to cause problems than some other fruits) Four (4) servings of vegies (have yellow and green at least once a day) Four (4) servings of protein (no-fat dairy, poultry, fish, meat or legumes) Eight (8) servings of grains (cereal, rice, bread, etc.)Eat small meals. The first meal of the day sometimes does not cause as many problems as meals eaten later in the day. Experiment and adjust your eating schedule to produce the least amount of symptoms. Some people have found that oatmeal relieves their symptoms. Reduce stress in your life Engage in pleasant pastimes and activities. After work, or a stressful day, do someting nice for yourself or something you find relaxing and fun. Stay out of stressful situations. If you are involved in family, job, or other situations that are causing you stress try to see how you can minimize them (leaving the house to take a walk) Do self hypnosis, meditation, prayer, and stress reduction techniques (these are found back on "Hints" home page). Go on a retreat at a religious community Do an evaluation of your work and family situation. Determine what changes to get your life in balance. Remember good health is a balance of social, mental, physical, spiritual, recreational and vocational aspects of life. Physical Exercise Get some exercise every day. Even walking briskly about ten minutes three times a day can be helpful to overall health. Attempt to spend a half hour a day for at least three days a week in some form of physical activity. Lose weight if overweight. Exercise can help you with this and also curb your appetite. Find a supportive physician Find a physician that will spend time to be supportive, will encourage lifestyle change efforts and is accepting of diatary and alternative health prevention regimens. Discuss with your health care provider the possibility of massage therapy or accupuncture Take the medication prescribed by physician Anti-spasmotics, nitrates and calcium channel blokers may help with the pain as an adjunct to changing diet, stress reduction and exercise. --------------------------------------------------------------------------------Links to further information about this and similar disorders. Since you will be linked to off-site webpages bookmark this page so you can come back to it: Biliary Dyskinesia & Sphincter of Oddi Dysfunction Information about the Types of billary dysfunctions Medical University of South Carolina information about Sphincter of Oddi Information about MRCP for diagnosis Information about ERCP for diagnosis and treatment MRCP vs ERCP IU Medical School Medical Information from the Am. Soc. Gast. Endoscopy Other GI Functional Disorders Abdominal Pain Med Help International


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## LadyM (Feb 17, 2001)

Genny,I enjoyed reading this post. It stated that some people find that oatmeal relieves their symptoms. Funny thing was that oatmeal is what was the first food that I could keep in my stomach after GB surgery. It was a life saving food for me. Because nothing else would stay in my stomach very long. They thought they might have left a gallstone in my duct, so they did another Hida Scan of my duct. I had the hida scan done before I had my gallbladder out to see what my ejection fraction was and then they did the Hida Scan to check to see if any stones was lefted in the duct after GB surgery. I never have read where anyone has had the hida scan done after gb surgery to check for stones? Anyways mine came up negative. I really enjoyed reading this article but the only way I would have a ercp done is in an er situation.


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