{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T23:08:12Z","timestamp":1774998492865,"version":"3.50.1"},"reference-count":33,"publisher":"BMJ","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Gut"],"published-print":{"date-parts":[[1989,6]]},"abstract":"<jats:p>Ever since its description approximately 100 years ago, the sphincter of Oddi has been surrounded by controversy. First, whether it indeed existed, second, whether it had a significant physiological role in man and more recently whether abnormalities in its function give rise to a clinical syndrome. Data from animal and human studies, using sensitive techniques, have helped define the physiological role of the sphincter of Oddi, and more recent studies are determining the factors which control sphincter of Oddi function. These studies support Oddi's original description that the sphincter has a major role in the control of flow of bile and pancreatic juice into the duodenum, and equally importantly helps prevent the reflux of duodenal contents into the biliary and pancreatic ductal systems. The controversy of whether abnormalities in sphincter of Oddi motility result in clinical syndromes has not been totally resolved. Part of the difficulty has been inability to document normal and hence abnormal function of the sphincter. With the emergence of endoscopic biliary manometry as a sensitive and reproducible technique, however, the motility of the human sphincter of Oddi has come under closer scrutiny and allowed definition of possible disorders. We have used the term sphincter of Oddi dysfunction to define manometric abnormalities in patients who present with signs and symptoms consistent with a biliary or pancreatic ductal origin. Based on the manometry, we have subdivided the dysfunction into two groups; a group characterised by a stenotic pattern - that is, raised sphincter basal pressure - and a second group having a dyskinetic pattern - that is, paradoxical response to cholecystokinin injection, rapid contraction frequency, high percentage of retrograde contractions, or short periods of raised basal percentage of retrograde contractions, or short periods of raised basal pressure. It is apparent from the mamometry but also from the clinical data that the patients are a heterogeneous group and thus any therapy would need to be tailored for each patient and abnormality. The most recent therapeutic data suggest that patients with the stenotic pattern on manometry respond to division of the sphincter, however, those patients with the dyskinetic manometric pattern show no significant effect after sphincterotomy. Further prospective trials evaluating therapeutic options are under way and their results are eagerly awaited.<\/jats:p>","DOI":"10.1136\/gut.30.6.753","type":"journal-article","created":{"date-parts":[[2007,9,18]],"date-time":"2007-09-18T17:41:31Z","timestamp":1190137291000},"page":"753-761","source":"Crossref","is-referenced-by-count":44,"title":["What is sphincter of Oddi dysfunction?"],"prefix":"10.1136","volume":"30","author":[{"given":"J","family":"Toouli","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[1989,6,1]]},"reference":[{"issue":"8","key":"ref_1","first-page":"317","article-title":"D'une disposition a sphincter speciale de l'ouverture du canal cholidoque","volume":"1887","author":"R, I.Oddi","unstructured":"I Oddi R. D'une disposition a sphincter speciale de l'ouverture du canal cholidoque. Arch Ital Biol 1887; 8: 317-22.","journal-title":"Arch Ital Biol"},{"key":"ref_2","first-page":"231","article-title":"Postsurgical syndromes. Clin Gastroenterol","volume":"12","author":"Tondelli, P.; Gyr, K.","year":"1983","unstructured":"Tondelli P, Gyr K. Postsurgical syndromes. Clin Gastroenterol 1983; 12: 231-54."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1149","DOI":"10.1016\/S0039-6109(16)40143-X","article-title":"Papillitis and stenosis of the sphincter of Oddi","volume":"53","author":"Nardi, G.L.","year":"1973","unstructured":"Nardi GL. Papillitis and stenosis of the sphincter of Oddi. Surg Clinics North Am 1973; 53: 1149-60.","journal-title":"Surg Clinics North Am"},{"key":"ref_4","first-page":"1243","article-title":"Manometric disorders in patients with suspected sphincter","volume-title":"of Oddi dysfunction. Gastroenterology 1985; 88","author":"Toouli, J.; Roberts-Thomson, I.; Dent, J.; Lee, J.","unstructured":"Toouli J, Roberts-Thomson I, Dent J, Lee J. Manometric disorders in patients with suspected sphincter of Oddi dysfunction. Gastroenterology 1985; 88: 1243-50."},{"key":"ref_5","first-page":"25","article-title":"The sphincter of Oddi in man and certain representative mammals","volume":"1","author":"Boyden, E.A.","year":"1937","unstructured":"Boyden EA. The sphincter of Oddi in man and certain representative mammals. Surgery 1937; 1: 25-37.","journal-title":"Surgery"},{"key":"ref_6","first-page":"641","article-title":"The anatomy of the choledochoduodenal junction in man","volume":"104","author":"Boyden, E.A.","year":"1957","unstructured":"Boyden EA. The anatomy of the choledochoduodenal junction in man. Surgery 1957; 104: 641-52.","journal-title":"Surgery"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1016\/0016-5085(82)90131-7","article-title":"Sphincter of Oddi motor activity: a comparison between patients with common bile stones and controls","volume":"82","author":"Toouli, J.; Geenen, J.E.; Hogan, W.J.; Dodds, W.J.; Arndorfer, R.C.","year":"1982","unstructured":"Toouli J, Geenen JE, Hogan WJ, Dodds WJ, Arndorfer RC. Sphincter of Oddi motor activity: a comparison between patients with common bile stones and controls. Gastroenterology 1982; 82: 111-7.","journal-title":"Gastroenterology"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"208","DOI":"10.1172\/JCI110761","article-title":"Motor function of the opossum sphincter of Oddi","volume":"71","author":"Toouli, J.; Dodds, W.J.; Honda, R.","year":"1983","unstructured":"Toouli J, Dodds WJ, Honda R, et al. Motor function of the opossum sphincter of Oddi. J Clin Invest 1983; 71: 208-20.","journal-title":"J Clin Invest"},{"key":"ref_9","first-page":"12319","article-title":"Effect of cholecystokinin and the octapeptide of cholecystokinin on the feline sphincter of Oddi and gallbladder. Mechanisms of action","volume":"66","author":"Behar, J.; Biancani, P.","year":"1980","unstructured":"Behar J, Biancani P. Effect of cholecystokinin and the octapeptide of cholecystokinin on the feline sphincter of Oddi and gallbladder. Mechanisms of action. J Clin Invest 1980; 66: 12319.","journal-title":"J Clin Invest"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"286","DOI":"10.1097\/00000658-196502000-00018","article-title":"Functional studies of the extrahepatic biliary system in the dog by use of a controlled biliary fistula","volume":"161","author":"Berci, G.; Johnson, N.","year":"1965","unstructured":"Berci G, Johnson N. Functional studies of the extrahepatic biliary system in the dog by use of a controlled biliary fistula. Ann Surg 1965; 161: 286-92.","journal-title":"Ann Surg"},{"key":"ref_11","first-page":"502","article-title":"Interdigestive and post-prandial contractile activity of the human sphincter of Oddi","volume":"17","author":"Worthley, C.S.; Baker, R.A.; Saccone, G.T.P.; lannos J; McGee, M.; Toouli, J.","year":"1987","unstructured":"Worthley CS, Baker RA, Saccone GTP, lannos J, McGee M, Toouli J. Interdigestive and post-prandial contractile activity of the human sphincter of Oddi. Aust NZ J Med 1987; 17: 502.","journal-title":"Aust NZ J Med"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"770","DOI":"10.1172\/JCI110515","article-title":"Relationship of sphincter of Oddi spike bursts to gastrointestinal myoeletric activity in conscious opossums","volume":"69","author":"Honda, R.; Toouli, J.; Dodds, W.J.; Sarna, S.; Hogan, W.J.; Itoh, Z.","year":"1982","unstructured":"Honda R, Toouli J, Dodds WJ, Sarna S, Hogan WJ, Itoh Z. Relationship of sphincter of Oddi spike bursts to gastrointestinal myoeletric activity in conscious opossums. J Clin Invest 1982; 69: 770-8.","journal-title":"J Clin Invest"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"487","DOI":"10.1016\/S0300-5089(21)00437-5","article-title":"The biliary tract","volume":"8","author":"Tondelli, P.; Gyr, K.; Stalder, G.A.; Allgower, M.","year":"1979","unstructured":"Tondelli P, Gyr K, Stalder GA, Allgower M. The biliary tract. Cholecystectomy. Clin Gastroenterol 1979; 8: 487-505.","journal-title":"Cholecystectomy. Clin Gastroenterol"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"859","DOI":"10.1002\/bjs.1800721104","article-title":"Sphincter of Oddi manometric disorders in patients with idiopathic recurrent pancreatitis","volume":"72","author":"Toouli, J.; Roberts-Thomson, I.; Dent, J.; Lee, J.","year":"1985","unstructured":"Toouli J, Roberts-Thomson I, Dent J, Lee J. Sphincter of Oddi manometric disorders in patients with idiopathic recurrent pancreatitis. Br J Surg 1985; 72: 859-63.","journal-title":"Br J Surg"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1367","DOI":"10.1136\/gut.26.12.1367","article-title":"Abnormal responses to morphine neostigmine in patients with undefined biliary-type pain","volume":"26","author":"Roberts-Thomson, I.; Toouli, J.","year":"1985","unstructured":"Roberts-Thomson I, Toouli J. Abnormal responses to morphine neostigmine in patients with undefined biliary-type pain. Gut 1985; 26: 1367-72.","journal-title":"Gut"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"802","DOI":"10.1007\/BF01318422","article-title":"Secretin administration induces a dilatation of the main pancreatic duct","volume":"29","author":"Bolondi, L.; Gaiani, S.; L, Gullo; Labo, G.","year":"1984","unstructured":"Bolondi L, Gaiani S, Gullo L and Labo G. Secretin administration induces a dilatation of the main pancreatic duct. Dig Dis Sci 1984; 29: 802-8.","journal-title":"Dig Dis Sci"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"779","DOI":"10.1016\/0016-5085(88)90254-5","article-title":"Efficacy of quantitative hepatobiliary scintigraphy and fatty meal sonography for evaluating patients with suspected partial common duct obstruction","volume":"94","author":"Darweesh, R.M.A.; Dodds, W.J.; Hogan, W.J.","year":"1988","unstructured":"Darweesh RMA, Dodds WJ, Hogan WJ, et al. Efficacy of quantitative hepatobiliary scintigraphy and fatty meal sonography for evaluating patients with suspected partial common duct obstruction. Gastroenterology 1988; 94: 779-86.","journal-title":"Gastroenterology"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"788","DOI":"10.1111\/j.1445-5994.1986.tb00038.x","article-title":"Assessment of bile flow by radioscintigraphy in patients with biliary-type pain after cholecystectomy","volume":"16","author":"Roberts-Thomson, I.C.; Toouli, J.; Blanchett, W.; M, Lichtenstein; Andrews, J.T.","year":"1986","unstructured":"Roberts-Thomson IC, Toouli J, Blanchett W, Lichtenstein M and Andrews JT. Assessment of bile flow by radioscintigraphy in patients with biliary-type pain after cholecystectomy. Aust NZ J Med 1986; 16: 788-793.","journal-title":"Aust NZ J Med"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"787","DOI":"10.1148\/radiology.156.3.4023244","article-title":"Postcholecystectomy syndrome; evaluation using biliary scintigraphy and endoscopic retrograde cholangiopancreatography","volume":"156","author":"Zcman, R.K.; Burrell, M.I.; Dobbins, J.","year":"1985","unstructured":"Zcman RK, Burrell MI, Dobbins J, et al. Postcholecystectomy syndrome; evaluation using biliary scintigraphy and endoscopic retrograde cholangiopancreatography. Radiology 1985; 156: 787-92.","journal-title":"Radiology"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"793","DOI":"10.1148\/radiology.156.3.4023245","article-title":"Sphincter of Oddi stenosis using hepatobiliary scintigraphy and endoscopic manometry","volume":"156","author":"Lee, R.G.; Gregg, J.A.; Koroshetz, A.M.","year":"1985","unstructured":"Lee RG, Gregg JA, Koroshetz AM, et al. Sphincter of Oddi stenosis using hepatobiliary scintigraphy and endoscopic manometry. Radiology 1985; 156: 793-6.","journal-title":"Radiology"},{"key":"ref_21","first-page":"317","article-title":"Intraluminal prcssurc recording from the human","volume-title":"sphincter of Oddi. Gastroenterology 1980","volume":"78","author":"Geenen, J.E.; Hogan, W.J.; Dodds, W.J.; Steward, E.T.; Arndorfer, R.C.","unstructured":"Geenen JE, Hogan WJ, Dodds WJ, Steward ET, Arndorfer RC. Intraluminal prcssurc recording from the human sphincter of Oddi. Gastroenterology 1980; 78: 317-24."},{"key":"ref_22","first-page":"349","article-title":"Perendoscopic versus intra-operative sphincter of Oddi manometry","volume":"17","author":"Toouli, J.","year":"1985","unstructured":"Toouli J. Perendoscopic versus intra-operative sphincter of Oddi manometry. Ital J Gastroenterol 1985; 17: 349-52.","journal-title":"Ital J Gastroenterol"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"363","DOI":"10.1136\/gut.27.4.363","article-title":"Frequencies and cyclical pattern of the human sphincter of Oddi phasic activity","volume":"27","author":"Torsoli, A.; Corazziari, E.; Habib, F.I.","year":"1986","unstructured":"Torsoli A, Corazziari E, Habib FI, et al. Frequencies and cyclical pattern of the human sphincter of Oddi phasic activity. Gut 1986; 27: 363-9.","journal-title":"Gut"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1247","DOI":"10.1136\/gut.25.11.1247","article-title":"Endoscopic pancreatic and biliary manometry in pancreatic. biliary and papillary disease and after sphincteroplasty","volume":"25","author":"Gregg, J.A.; Carr-Locke, D.L.","year":"1984","unstructured":"Gregg JA, Carr-Locke DL. Endoscopic pancreatic and biliary manometry in pancreatic. biliary and papillary disease and after sphincteroplasty. Gut 1984; 25: 1247-54.","journal-title":"Gut"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"243","DOI":"10.3109\/00365528708991887","article-title":"Endoscopic sphincter of Oddi manometry in healthy volunteers","volume":"22","author":"Funch-Jensen, P.; Kruse, A.; Ravnsbaek, J.","year":"1987","unstructured":"Funch-Jensen P, Kruse A, Ravnsbaek J. Endoscopic sphincter of Oddi manometry in healthy volunteers. Scand J Gastroenterol 1987; 22: 243-9.","journal-title":"Scand J Gastroenterol"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"859","DOI":"10.1002\/bjs.1800721104","article-title":"Sphincter of Oddi (SO) manometric disorders in patients with idiopathic relapsing pancreatitis","volume":"72","author":"Toouli, J.; Roberts-Thomson, I.C.; Dent, J.; Lee, J.","year":"1985","unstructured":"Toouli J, Roberts-Thomson IC, Dent J, Lee J. Sphincter of Oddi (SO) manometric disorders in patients with idiopathic relapsing pancreatitis. Br J Surg 1985; 72: 859-63.","journal-title":"Br J Surg"},{"key":"ref_27","first-page":"333","article-title":"Paradoxical lower oesophageal sphincter contraction induced by cholecystokinin-octapeptide","volume-title":"patients with achalasia. Gastroenterology 1981; 80","author":"Dodds, W.J.; Dent, J.; Hogan, W.J.; Patel, F.K.; Toouli, J.; Arndorfcr, R.C.","unstructured":"Dodds WJ, Dent J, Hogan WJ, Patel FK, Toouli J, Arndorfcr RC. Paradoxical lower oesophageal sphincter contraction induced by cholecystokinin-octapeptide in patients with achalasia. Gastroenterology 1981; 80: 333-7."},{"key":"ref_28","first-page":"94","article-title":"Nitrate therapy in a patient with papillary dysfunction","volume":"78","author":"S, Bar Meir; Z, Halpern; E, Bardan","year":"1983","unstructured":"Bar Meir S, Halpern Z, Bardan E. Nitrate therapy in a patient with papillary dysfunction. Am J Gastroenterol 1983; 78: 94-95.","journal-title":"Am J Gastroenterol"},{"key":"ref_29","article-title":"Effect of nifedipine on sphincter of Oddi motor function in humans. Studies in healthy volunteers and patients with biliary","volume-title":"dyskinesia [Abstracti. Gastroenterology 1987; 92: 1418","author":"Guclrud, M.; Mendoza, S.; Rossiter, G.","unstructured":"Guclrud M, Mendoza S, Rossiter G, et al. Effect of nifedipine on sphincter of Oddi motor function in humans. Studies in healthy volunteers and patients with biliary dyskinesia [Abstracti. Gastroenterology 1987; 92: 1418."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"627","DOI":"10.1097\/00000658-198305000-00017","article-title":"Transduodenal sphincteroplasty and transampullary septectomy for post-cholecystectomy pain","author":"Moody, F.G.; Becker, J.M.; Potts, JR","year":"1983","unstructured":"Moody FG, Becker JM, Potts JR. Transduodenal sphincteroplasty and transampullary septectomy for post-cholecystectomy pain. Ann Surg 1983; 197: 627-36.","journal-title":"Ann Surg"},{"key":"ref_31","first-page":"453","article-title":"Transduodenal sphincteroplasty 5-25 year follow-up of 89 patients","author":"Nardi, G.L.; Michelassi, F.; Zannini, P.","year":"1983","unstructured":"Nardi GL, Michelassi F, Zannini P. Transduodenal sphincteroplasty 5-25 year follow-up of 89 patients. Ann Surg 1983; 198: 453-61.","journal-title":"Ann Surg"},{"key":"ref_32","first-page":"1401","article-title":"Longterm results of endoscopic sphincterotomy (ES) for treating patients with sphincter of Oddi (SO) dysfunction: A prospective study","volume":"92","author":"Geenen, J.E.; Hogan, W.J.; Dodds, W.J.; Toouli, J.; Venu, R.P.","year":"1987","unstructured":"Geenen JE, Hogan WJ, Dodds WJ, Toouli J, Venu RP. Longterm results of endoscopic sphincterotomy (ES) for treating patients with sphincter of Oddi (SO) dysfunction: A prospective study. Gastroenterology 1987; 92: 1401.","journal-title":"Gastroenterology"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1409","DOI":"10.1016\/0016-5085(88)90381-2","article-title":"Sphincter of Oddi dysfunction: a clinical controversy","volume":"95","author":"Steinberg, W.M.","year":"1988","unstructured":"Steinberg WM. Sphincter of Oddi dysfunction: a clinical controversy. Gastroenterology 1988; 95: 1409-15.","journal-title":"Gastroenterology"}],"container-title":["Gut"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/gut.30.6.753","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,13]],"date-time":"2025-12-13T14:34:35Z","timestamp":1765636475000},"score":1,"resource":{"primary":{"URL":"https:\/\/gut.bmj.com\/lookup\/doi\/10.1136\/gut.30.6.753"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[1989,6]]},"references-count":33,"journal-issue":{"issue":"6","published-online":{"date-parts":[[1989,6,1]]},"published-print":{"date-parts":[[1989,6]]}},"alternative-id":["10.1136\/gut.30.6.753"],"URL":"https:\/\/doi.org\/10.1136\/gut.30.6.753","relation":{},"ISSN":["0017-5749","1468-3288"],"issn-type":[{"value":"0017-5749","type":"print"},{"value":"1468-3288","type":"electronic"}],"subject":[],"published":{"date-parts":[[1989,6]]}}}