20 Basal pressure of Oddis sphincter mm Hg

Basal pressure of the sphincter of Oddi: manometry, the 40 mmHg threshold and sphincter of Oddi dysfunction.

The sphincter of Oddi is a ring of smooth muscle where the common bile duct and the pancreatic duct open into the duodenum. It controls the flow of bile and pancreatic juice into the gut and prevents reflux of intestinal contents into the ducts. Its basal (resting) pressure is the pressure the sphincter maintains between contractions; superimposed phasic contractions occur several times a minute. Abnormal function, called sphincter of Oddi dysfunction, can obstruct the outflow of bile or pancreatic juice and cause recurrent biliary-type pain, typically after removal of the gallbladder, sometimes with raised liver enzymes or pancreatitis.

Biliary tractPancreasManometry

Abnormal basal pressure> 40 mmHg

Reference methodsphincter of Oddi manometry (ERCP)

Typical patientpain after cholecystectomy

Main risk of testingpost-procedure pancreatitis

Figure 1. Sphincter of Oddi basal pressure. A resting pressure above 40 mmHg is the conventional criterion of sphincter dysfunction on manometry.

Measurement

The reference method is manometry during endoscopic retrograde cholangiopancreatography (ERCP): a thin water-perfused catheter is placed across the sphincter and the pressure is recorded. The procedure carries a significant risk of pancreatitis, so it is reserved for selected patients. Non-invasive tests (liver enzymes during pain, ultrasound of duct diameter, hepatobiliary scintigraphy, MRCP) are used first to look for obstruction and exclude stones and tumours. In this application the value is estimated from other parameters.

Clinical significance

Biliary sphincter dysfunction: episodes of severe upper abdominal or right-sided pain lasting 30 minutes or more, with raised liver enzymes or a dilated bile duct; sphincterotomy can help when objective obstruction is present
Pancreatic sphincter dysfunction: may contribute to recurrent acute pancreatitis
Pain without objective findings (formerly "type III"): in the EPISOD randomised trial, endoscopic sphincterotomy was no better than a sham procedure, and manometry did not predict the result; such patients are not treated with sphincterotomy
Opioids raise sphincter pressure and can provoke biliary-type pain

Seek emergency care

for severe abdominal pain with fever, jaundice, vomiting or pain radiating to the back.

References

Cotton PB, Elta GH, Carter CR, Pasricha PJ, Corazziari ES. Gallbladder and sphincter of Oddi disorders. Gastroenterology. 2016;150(6):1420–1429. doi:10.1053/j.gastro.2016.02.033
Cotton PB, Durkalski V, Romagnuolo J, et al. Effect of endoscopic sphincterotomy for suspected sphincter of Oddi dysfunction on pain-related disability following cholecystectomy: the EPISOD randomized clinical trial. JAMA. 2014;311(20):2101–2109. doi:10.1001/jama.2014.5220

This article is for general information and does not replace a consultation with a doctor. Measurements must be interpreted by a physician together with symptoms and other tests.

Published on 21 April 2024