Sphincter of Oddi Dysfunction after Bariatric Surgery and Trends in Management

John N Afthinos, MD, Roman Grinberg, MD, Karen E Gibbs, MD. Staten Island University Hospital

Introduction: Sphincter of Oddi dysfunction (SOD) is a rare disorder which can be difficult to diagnose and treat. It has been identified in patients who have undergone gastric bypass. Many times, testing is negative for any significant abnormalities, yet significant upper abdominal pain and interruption of daily life occurs frequently. We sought to query a large national database to better characterize patients with SOD with a focus on patients who have had weight loss surgery.

Methods: The NIS Database was queried for 2005 – 2010 for all patients admitted with a diagnosis of sphincter of Oddi spasm (ICD-9M 576.5). The patients were characterized for their age, gender, comorbid conditions and a history of prior bariatric surgery. We evaluated any interventions performed. Multivariate regression analyses were performed to identify factors predicting an intervention.

Results: A total of 3,601 patients were identified, of which 116 (3.2%) had a history of bariatric surgery (BHx). The majority of the BHx subgroup was female (96%). None of the BHx patients (0%) had documented enzymatic or transaminase abnormalities. ERCP was the most common procedure performed (19%) with laparoscopic cholecystectomy being performed on 14%. Nearly 9% underwent a diagnostic laparoscopy (DL). BHx was the strongest predictor of DL with an OR 18.8 (p < 0.0001).

Discussion: SOD is a rare admitting diagnosis. The BHx subgroup seems to demonstrate a type III SOD, as evidenced by the lack of serum transaminase and enzymatic abnormalities. The pain distribution and severity may mimic internal hernia, which warrants a DL in the patient with a history of gastric bypass. If the DL is negative, SOD should be included in the differential diagnosis of severe, episodic upper abdominal pain in this patient population.

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