Sphincter of Oddi dysfunction in patients addicted to opium: an unrecognized entity.
BACKGROUND
Opiate-induced sphincter of Oddi dysfunction (SOD) as a clinical entity has not been described.


METHODS
Eight chronic opium addicts (all men, mean age 61.3 years, mean duration of addiction 24.75 years) presenting with pancreatobiliary pain and a dilated bile duct with or without dilated pancreatic duct on abdominal US were studied. All patients underwent ERCP and biliary sphincterotomy. In addition, pancreatic sphincterotomy was performed in 4 patients with a dilated pancreatic duct.


METHODS
At ERCP, the bile duct was dilated in 8 and pancreatic duct in 4 patients. There was delayed drainage of contrast (>45 minutes) from the bile duct in all 7 patients studied, whereas delayed drainage from the pancreatic duct (>9 minutes) was incidentally observed in 3 patients. In 6 patients followed after sphincterotomy for at least 2 years, there was marked relief of symptoms. Transabdominal US at 2 years follow-up revealed a normal bile duct in 5 and persistent albeit minimal dilatation in 1 patient. Acute pancreatitis developed in 4 patients after ERCP and sphincterotomy, which was fatal in one. No patient had any abnormality in the gallbladder on initial or follow-up transabdominal US.


CONCLUSIONS
SOD in opium addicts is a distinct clinical entity, mainly seen in men in this population, that is characterized by a long history of opium addiction and the absence of prior cholecystectomy or associated gallstone disease. Most patients are seen with the classic clinical picture of SOD with marked long-term improvement in symptoms after endoscopic sphincterotomy.
Sharma
Shyam Sundar
SS
Department of Gastroenterology, S.M.S. Medical College and Hospital, D-163 Shavitri Path, Bapu Nagar, Jaipur-302015 (Rajasthan), India.
D000368:Aged; D002760:Cholangiopancreatography, Endoscopic Retrograde; D003137:Common Bile Duct Diseases / Q000139:chemically induced*; D003937:Diagnosis, Differential; D006801:Humans; D007565:Jaundice / Q000209:etiology; D008297:Male; D008875:Middle Aged; D009293:Opioid-Related Disorders; D009892:Opium / Q000009:adverse effects* / Q000494:pharmacology; D009803:Sphincter of Oddi / Q000187:drug effects* / Q000503:physiopathology; D016717:Sphincterotomy, Endoscopic
D009892:Opium