What is biliary dyskinesia?
Biliary dyskinesia refers to the abnormal motility of either the gallbladder or bile ducts that cause upper right abdominal pain in the absence of gallstones . The condition can occur in adults and children [2,8].
There are 2 main types of biliary dyskinesia :
- Gallbladder dyskinesia (described in this article)
- Sphincter of Oddi dysfunction (SOD), which affects the common bile duct and can occur in individuals with or without gallbladder
What is gallbladder dyskinesia?
Gallbladder dyskinesia is a motility disorder of the gallbladder. Synonyms include functional gallbladder disorder, gallbladder spasm, acalculous biliary disease and chronic acalculous cholecystitis.
Symptoms and Signs
Symptoms and signs of biliary dyskinesia have been described by “Rome IV criteria :”
- The pain appears in the upper middle or upper right abdomen, builds up to a steady level, lasts at least 30 minutes and is severe enough to affect the daily activities.
- The pain is recurrent but does not occur at regular intervals or every day.
- The pain is not significantly relieved by passing gas, having a bowel movement or taking gastric acid-lowering drugs, such as antacids, H2 blockers (ranitidine, cimetidine) or omeprazole.
- No gallstones, gallbladder sludge or other organic (physical) disorder of the gallbladder are found.
The pain is constant (not crampy), can be mild or severe, can last for several hours and is not affected by breathing or body movements . The upper right abdomen can be slightly tender to touch . Additional symptoms can include pain in the right middle back or shoulder blade, excessive sweating (diaphoresis), nausea, vomiting and unintended weight loss . According to anecdotal reports, pain often appears in the early morning, after meals or during menstruation.
Fever, chills, belching, bloating, excessive gas (flatulence), burning pain, diarrhea and jaundice are not typical symptoms of biliary dyskinesia [9,14].
A doctor can evaluate the gallbladder function by performing the CCK-HIDA scan (CCK is the hormone cholecystokinin–used as a drug–that stimulates the gallbladder contraction; HIDA refers to hepatobiliary scan). This imaging investigation includes an injection of a contrast substance into a vein and taking images of its flow through the liver and gallbladder. When the amount of the substance expelled out of the gallbladder–expressed as the ejection fraction (EF)–is lower than 40%, the gallbladder function is considered poor, in which case a doctor usually suggests surgical removal of the gallbladder [1,5].
Typical findings in gallbladder dyskinesia are normal laboratory blood tests for liver enzymes (aminotransferases, alkaline phosphatase, gamma-glutamyl transpeptidase (GGT)), pancreatic enzymes (amylase, lipase) and bilirubin, normal abdominal ultrasound, X-ray, CT and MRI and normal upper endoscopy .
Chart 1. Differential Diagnosis of Gallbladder Dyskinesia
Chart 1. References: [3,5]
Surgical gallbladder removal (cholecystectomy) results in pain relief in more than 90% of the individuals with gallbladder dyskinesia [1,4]. The effectiveness of surgery is greater in those who have typical symptoms (upper right abdominal pain after meals) and in those who feel pain during the CCK-HIDA scan [5,6] than in those whose main symptoms are bloating, nausea, vomiting, constipation or diarrhea . NOTE: More clinical trials are needed to evaluate the effectiveness of gallbladder removal in individuals with gallbladder dyskinesia .
There is INSUFFICIENT EVIDENCE of the effectiveness of anti-inflammatory and prokinetic drugs (domperidone, metoclopramide), nitrates and nifedipine in relieving pain [5,13].
If you have the diagnosis of “gallbladder dyskinesia,” you will more likely benefit from gallbladder removal, if your main symptom is abdominal pain (rather than nausea) after meals, the pain was provoked during CKK-HIDA scan test and the ejection fraction of your gallbladder was <40%.
- George J et al, 2009, Gallbladder and biliary dyskinesia PubMed
- Biliary pain without gallstones Merck Manual, Home Edition
- Baillie J, 2010, Sphincter of Oddi dysfunction PubMed
- Tooli J, 2002, Biliary dyskinesia PubMed
- Zakko SF et al, 2016, Functional gallbladder disorder in adults UpToDate
- Carr JA et al, 2009 The treatment of gallbladder dyskinesia based upon symptoms: results of a 2-year, prospective, nonrandomized, concurrent cohort study PubMed
- Geiger TM et al, 2008, Prognostic indicators of quality of life after cholecystectomy for biliary dyskinesia PubMed
- Campbell BT et al, 2004, Biliary dyskinesia: a potentially unrecognized cause of abdominal pain in children PubMed
- Seetharam P et al, 2008, Sphincter of Oddi and its Dysfunction PubMed Central
- Gurusamy KS et al, 2009, Need for further randomised clinical trials to assess the role of cholecystectomy in patients with suspected gallbladder dyskinesia Cochrane.org
- FAQs about sphincter of Oddi dysfunction John Hopkins Medicine
- Sherman S et al 2001, Sphincter of Oddi Dysfunction: Diagnosis and Treatment Journal of the Pancreas
- Ruser C, 2005, Biliary Dyskinesia Clinical Advisor
- Biliary Tract Disorders, Gallbladder Disorders, and Gallstone Pancreatitis American College of Gastroenterology