Re: Thanks Telman...

I am afraid that I don't have very much but it may be useful for yourself and others to make some connections.

Sphincter of Oddi dysfunction (SOD) is a very difficult area, to understand, to diagnose and to treat effectively. Because of the relatively high technology needed to carry out the diagnostic tests it is mainly diagnosed in the USA rather than anywhere else. Consequently most people in other parts of the world apart the USA doesn’t get treatment except for general drug therapy.

From the drugs abuse research it is known that users of narcotics (morphine, codeine) commonly get spasm of the Sphincter of Oddi and this leads to SOD. Also amyl nitrite (called an upper by the drug fraternity) causes the sphincter to relax. The Chinese use these drugs in hospital for a treatment of gallstones. We can learn from this that some drugs can be responsible for changing the way that the sphincter operates and may lead to SOD.

Also small stones, sludge, small benign growth, hives and even parasites can upset the muscular action of the sphincter. The muscle gets tired, cramps, spasms and operates dysfunctionally. I suppose there are many other very and unknown things that can upset the functioning of the sphincter muscle, its nerves and hormone trigger mechanism.

People who have this problem can be divided into three broad groups and as you say you are probably in group 2.

Group 1 - have biliary pain, abnormal liver, in particular, elevations in serum transaminase levels of 1.5 times, and a dilation of the common bile duct greater than 12mm. Nearly all, about 95%, of type 1 people are cured by endoscopic biliary sphincterotomy (EBS)

Group 2 - have biliary pain and either abnormal liver function or a dilated common bile duct. This group should also have a biliary manometer test to ascertain whether the pressure of the biliary system is normal. These people have an 80% probability of improvement but it falls to about 30% if the biliary pressure is normal. From this we can learn that a dilated common bile duct in isolation isn't the important factor it has to be present with a higher biliary pressure to warrant surgery.

So far you haven't said anything about having a liver function test which to my mind is a good indicator to whether the bile is backing up into the liver and contaminating the blood.

Group 3 just have the biliary pain. People in this group don't fair that well with surgery. Only a third has an improvement and they appear to be prone to complications.

A vegetarian option is interesting path because they suffer very little from biliary problems. The liver and gallbladder still function because many foods cause bile to be released. Cabbage, radish and beets utilise the bile as a carrier for minerals. Purslane (parslane) which is a plump salad leaf common in the Mediterranean is rich in omega 3 essential oils is an excellent food. Tea made from the seeds is also beneficial to the pancreas. There are many other foods that you will find in your search for a satisfactory diet.

A basic activity of cleaning the biliary system is to make plenty of fresh bile and make sure that a good percentage of the old bile is expelled. The pectin (a high fibre compound) in apples and fibre in other foods like oats helps to refresh bile. Other fruits like blackcurrants and gooseberries are rich pectin.

By the way, is your citrus intolerance due to the citrus family or citric acid ? If you have the citrus fruit intolerance then you can use blackcurrant juice which has a citric acid concentration equivalent to lemons and limes.

I would like to draw you attention to rhubarb. According to laboratory studies rhubarb relaxes the Sphincter of Oddi. Rhubarb is taken in two ways lightly stewed as a desert which can be enhanced by the addition the crystallised ginger, and the medicinal root and rhizome.

Rhubarb may be useful in treating severe acute pancreatitis because it promotes gallstone elimination and controls infection of the biliary tract by greatly relaxing the sphincter of Oddi. It contributes to the smooth flow of bile and pancreatic fluid as well as controlling biliary inflammation. It inhibits excessive activity of pancreatic enzymes. It also protects pancreatic cells.

Some trials indicate that rhubarb taken by people suffering from severe pancreatitis was very effective in relieving symptoms in 9 out of 10 people.

Yoga, tai chi, or any other stretching is very beneficial as it helps to clean and condition the body. Gentle rhythmic motion such as brisk walking moves the abdomen and the internal organs in a way that increases its efficiency.

Supplements for SOD and pancreatitis are not discussed in any depth, if at all, in books and helpful websites. If the herbal remedy or supplement is a good match to the condition you are trying to treat and your metabolism is receptive there can work wonders. Occasionally there have a negative response but mostly their effect isn’t quantifiable but the expectation and the overwhelming desire to get well leaves one confused whether it worked or not. There are plenty of biliary concoctions available to try if you want to; Chanca Piedra found in ROYAL BREAK-STONE Tea has a good reputation. Common foods such as raw grated beetroot with a little apple cider vinegar are an excellent addition to a salad and a powerful biliary medicine.

A study of thirteen patients was the first to observe the effects of acupuncture on sphincter of Oddi motility in humans. Stimulation of the acupuncture point GB-34 (Yang Ling Quan) inhibited sphincter of Oddi contractions. This study suggests that acupuncture may be one alternative treatment for people with sphincter of Oddi dysfunction.

Endoscopic Ultrasound Scan (EUS) will give you a very clear and superior picture of you bile duct and I hope it provides some valuable clues to your plight.