Etiology and Pathogenesis of Sphincter of Oddi Dysfunction Hypothesis

Levin MD

Published on: 2024-08-06

Abstract

Introduction: The sphincter of Oddi (SO) is responsible for the portioned release of bile and pancreatic juice into the duodenum and prevents reflux of duodenal chyme into the bile ducts. The etiology and pathogenesis of sphincter of Oddi dysfunction (SOD) is considered unknown. The normal anatomy of SO is described based on the results of examination of patients with SOD. The disease is diagnosed if SO pressure exceeds 40 mmHg, while the norm is defined as 10 mmHg. Both conservative and surgical treatment are aimed at reducing pressure, including with the intersection of SO, which inevitably damages its anti-reflux function. After examination and treatment, severe complications arise, which raises doubts among some authors about the advisability of their use.

Objective: To isolate reliable scientific information from published materials and evaluate them from the point of view of the physiology of the digestive system.

Material and Methods: An analysis of the literature was carried out to determine the reliability of the results on which the diagnosis and treatment of SOD is based. Based on our own studies of normal and pathological physiology of the duodenum, a hypothesis of the occurrence of acquired diseases of the biliary system has been proposed.

Results: It has been shown that hypersecretion of hydrochloric acid, which causes other acid-dependent diseases (ulcers, gastritis, duodenitis, gastroesophageal reflux), leads to dyskinesia and hypertrophy of the Ochsner and Kapandji sphincters, because of which in the duodenal segment, between these sphincters, where the SO opens, the pressure increases. This causes dysfunction of SO, increased pressure in the biliary and pancreatic tracts, duodeno-biliary reflux, stone formation, and inflammation in the gallbladder.

Conclusion: A hypothesis has been proposed to understand the etiology and pathogenesis of sphincter of Oddi dysfunction as one of the clinical manifestations of hydrochloric acid hypersecretion. This hypothesis explains many scientific facts that were hitherto considered to be of unknown origin. Based on this hypothesis, diagnostic and treatment methods have been proposed that cannot cause the complications that are observed when using manometric study of the SO, ERCP, sphincterotomy and sphincteroplasty of the SO. However, studies are needed to confirm the effectiveness of this theoretically based treatment method.