I Just Diagnosed a Case of SOD, Although I Admit I Wasn’t Quite Familiar With It

Burt had his gallbladder out twenty years ago. But he had these recurring attacks of pain in his right upper quadrant that built up slowly and lasted for hours and then gradually disappeared.

Other doctors had checked him out and an ultrasound showed nothing unusual, such as an abnormal diameter of his common bile duct. He had even had a normal HIDA scan. Both were done fasting, the usual way.

As I listened to his story, I felt sure this was biliary, but what? It came and went and he was fine between. One time he remembered it happened the night after a high fat meal.

I’ve had patients who needed an ERCP to remove small gallstones at the sphincter of Oddi or to dilate or stent sphincters damaged by inflammation or tumors. But his symptoms were not chronic and he couldn’t very well have a stenosis present that way.

“Sphincter of Oddi dysfunction”, I thought to myself and logged in to UpToDate. “I pay $500 per year for this database”, I started. “I think you can have a bad valve, that lets the bile through some of the time and not others. Let me check something.”

And there, on my laptop screen in front of us, I had the classic symptoms, the Rome criteria which he checked off one by one. We scrolled down to the diagnostic testing. Ultrasound or HIDA scan after a fatty meal (of course!!!), invasive manometry (ugh!). Further down, the answer I was looking for: Antispasmodics may work. (I am linking to two different, free, articles here and here.)

So Burt is sticking to his low fat diet with a new prescription for PRN hyoscyamine.

We shall see…

P.S. Am I the only family doc who didn’t have this diagnosis right at my fingertips?