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 [1]. The condition can occur in adults and children [2,8].
There are 2 main types of biliary dyskinesia [1]:
- 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 [5]:”
- 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 [11]. The upper right abdomen can be slightly tender to touch [12]. Additional symptoms can include pain in the right middle back or shoulder blade, excessive sweating (diaphoresis), nausea, vomiting and unintended weight loss [5]. 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].
Diagnosis
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 [5].
Chart 1. Differential Diagnosis of Gallbladder Dyskinesia |
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Chart 1. References: [3,5]
Treatment
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 [7]. NOTE: More clinical trials are needed to evaluate the effectiveness of gallbladder removal in individuals with gallbladder dyskinesia [10].
There is INSUFFICIENT EVIDENCE of the effectiveness of anti-inflammatory and prokinetic drugs (domperidone, metoclopramide), nitrates and nifedipine in relieving pain [5,13].
End Note
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%.
- References
- 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
My 9 years old daughter has been complainning of RUQ abd pain rating a a 8-9/10 sharp like needles radiating to back or right side and now with radiation to right leg like needles. At this moment it doesn;t make a difference if it is after eating something. She has nause but no vomiting and her VS are always ok. they did a hida with no cck but was ok. US showed possible biliary sludge. her pain is preventing her to go to school. the GI dr. told me to take her to school but she is in so much pain to go. GI dr. said that it could be gallbladder disease but when I read biliary dyskinesia sound like my daughter. HIDA WITH cck will be repeated on tuesday… Tylenol is not helping for her pain and ibuprofen she cannot take it… any help?
First what you can do is to ask the doctors for exact diagnosis after they do the HIDA scan.
I have had hida scan and it suggests gallbladder dyskinesia what is the cause for this condition and what is best solution for fixing it
Gallbladder dyskinesia means that the gallbladder is not filling and emptying properly. The cause is often not known, but it is sometimes related to stress. If there is no symptoms, there’s nothing need to do. If there is pain, a usual treatment is gallbladder removal, but before that one can try to change the diet and lifestyle, maybe, and see if it helps.
I don’t know what to do. I have been diagnosed with biliary dyskinesia about 2 months ago (after suffering 2 full-blown gallbladder attacks earlier in the year) and about 6 months of random pain (that leads to nausea), gas and belching. At this point I always have a dull pain in my right side (like a stitch), but this past week I can barely eat anything…if I do I immediately have pain and gas. I had GB surgery scheduled, but cancelled as I was fearful of the surgery and outcome. But now I’m getting scared. This pain is debilitating. I have lost a lot of weight. There are times when I can eat pretty much whatever I want and then there are times like this week where I can barely eat anything at all without pain. Has anyone found ANYTHING that works for the pain? I really don’t want surgery, but I am becoming desperate.
Did they confirm gallstones by ultrasound?
Do you have grey or white sticky stools? If not, belching and gas may not be due to gallstones, even if you have them. You may want to read about trapped gas and try to eliminate some food from your diet. Stress can also aggravate gas pain.
Lisa, hope you found your way to a GI superspecialist, with lots of experience with biliary dyskinesia/functional gall bladder disorders that might neither require, nor benefit from surgical removal. The specialist needs to review all the tests, all imaging, including HIDA scan to assess gall bladder emptying. I went through hell until consulting with such a specialist in New York City (Dr. Jerome Siegel) and at Massachusetts General Hospital. The upshot: a couple of prescriptions and watch the greasy foods, and, within a couple of weeks, I was so much better. That was 9 years ago. I don’t know if you have or would find the same answers. I do hope you have found a gastroenterologist who has a special focus in gall bladder disorders, and who is willing to consider whether surgical removal or medical management is in your best interest.
Is removal really the ONLY treatment????? I dont have the funds for that!!!
Treatment for biliary dyskinesia? Have you got any diagnosis yet?
hahaha, you have problem with organ X, let’s just cut it away, you don’t need it… well after gallbladder removal, most people have fecal incontinence & still bloating and all the other symptoms
It is true that some people will have loose stools for some time after gallbladder removal and some may have long-term problems, so gallbladder should be removed only when really necessary.