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Rome IV Diagnostic Criteria for Functional Pancreatic Sphincter of Oddi Disorder (SOD)
Diagnosis of recurrent idiopathic pancreatitis attributed to pancreatic sphincter dysfunction.
Rome IV Diagnostic Criteria for Functional Pancreatic Sphincter of Oddi Disorder (SOD)
Documented recurrent episodes of pancreatitis
Typical pancreatic-type pain with amylase and/or lipase ≥3x the upper limit of normal, and/or imaging evidence of acute pancreatitis.
Other etiologies of pancreatitis excluded (e.g., gallstones/microlithiasis, alcohol, hypertriglyceridemia, anatomic variants, drugs)
Endoscopic ultrasound negative for structural or occult causes
Abnormal pancreatic sphincter of Oddi manometry
ResultCriteria not met
Does not meet Rome IV criteria for pancreatic SOD; continue evaluation for gallstones/microlithiasis, genetic and anatomic causes, or another identifiable etiology of recurrent pancreatitis.
When to use
- Recurrent, otherwise unexplained acute pancreatitis after a complete etiologic workup, when sphincter dysfunction is suspected.
Formula
Diagnosis requires all of: documented recurrent pancreatitis (typical pain with amylase/lipase ≥3x ULN and/or imaging evidence); other causes of pancreatitis excluded; negative EUS; abnormal sphincter of Oddi manometry.
Pearls and pitfalls
- Sphincter of Oddi manometry carries a meaningful risk of post-procedure pancreatitis and should be reserved for patients in whom the diagnosis will change management.