MDCalc

Rome IV Diagnostic Criteria for Functional Pancreatic Sphincter of Oddi Disorder (SOD)

Official Rome IV criteria for the diagnosis of functional pancreatic sphincter of oddi disorder.

Use in patients with recurrent episodes of pancreatitis with characteristic pain and appropriate lab elevations. Other common etiologies of pancreatitis must be excluded with a negative endoscopic ultrasound (EUS). 

Do NOT use in patients with:

  • Pancreatic type pain without objective evidence of pancreatitis.
  • Single episode of idiopathic pancreatitis.
  • Gallstones or sludge on imaging.
  • Culprit drugs associated with pancreatitis (including over the counter, supplements, narcotics).

Must have the following:

Diagnostic Result

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Advice

If criteria met (positive):

  • Perform biliary sphincterotomy (equivalent efficacy and lower procedural risk than dual pancreatic and biliary sphincterotomy).

If criteria NOT met (negative):

  • Consider alternative causes for recurrent pancreatitis such as genetic mutations, surreptitious medication/drug use including alcohol and/or opiates.

Critical Actions

This calculator should only be used for patients with objective acute recurrent idiopathic pancreatitis after thorough workup performed (including EUS +/- MRCP).

NOTE: this calculator is not validated for patients with chronic pancreatitis as other structural causes can lead to pain in this population such as focal strictures or pancreatic stones.