Biliary (Gallbladder) Dyskinesia: Causes, Symptoms, Treatment

Author:
Published: August 8, 2016
Last reviewed: January 13, 2017

What is biliary dyskinesia?

Biliary dyskinesia refers to abnormal motility of the gallbladder or bile ducts. It presents with 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]:

  1. Gallbladder dyskinesia (described in this article)
  2. Sphincter of Oddi dysfunction (SOD)

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 in 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, which can be mild or severe, and can last for several hours, is constant (not crampy) and 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 bladeexcessive sweating (diaphoresis), nausea, vomiting and unintended weight loss [5]. According to anecdotal reports, pain often appears in the early mornings, 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–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

  • Acute pancreatitis
  • Gastroparesis
  • Intestinal diseases (celiac disease, Crohn’s disease, ulcerative colitis)
  • Costochondritis
  • Bowel obstruction (ileus)
  • Kidney stones or other cause of the right kidney pain
  • Coronary heart disease
  • Pleurisy
  • Abdominal adhesions

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 need to be done to evaluate the effectiveness of gallbladder removal in individuals with gallbladder dyskinesia [10].

There is INSUFFICIENT EVIDENCE about the effectiveness of anti-inflammatory and prokinetic drugs (domperidone, metoclopramide), nitrates and nifedipine in reliving 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 after meals (rather then nausea), the pain was provoked during CKK-HIDA scan test (as opposed to no pain) and the ejection fraction of your gallbladder was <40% (as opposed to >40%).

  • References

      1. George J et al, 2009, Gallbladder and biliary dyskinesia  PubMed
      2. Biliary pain without gallstones  Merck Manual, Home Edition
      3. Baillie J, 2010, Sphincter of Oddi dysfunction  PubMed
      4. Tooli J, 2002, Biliary dyskinesia  PubMed
      5. Zakko SF et al, 2016, Functional gallbladder disorder in adults  UpToDate
      6. Carr JA et al, 2009 The treatment of gallbladder dyskinesia based upon symptoms: results of a 2-year, prospective, nonrandomized, concurrent cohort study  PubMed
      7. Geiger TM et al, 2008, Prognostic indicators of quality of life after cholecystectomy for biliary dyskinesia  PubMed
      8. Campbell BT et al, 2004, Biliary dyskinesia: a potentially unrecognized cause of abdominal pain in children  PubMed
      9. Seetharam P et al, 2008, Sphincter of Oddi and its Dysfunction  PubMed Central
      10. 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
      11. FAQs about sphincter of Oddi dysfunction  John Hopkins Medicine
      12. Sherman S et al 2001, Sphincter of Oddi Dysfunction: Diagnosis and Treatment  Journal of the Pancreas
      13. Ruser C, 2005, Biliary Dyskinesia  Clinical Advisor
      14. Biliary Tract Disorders, Gallbladder Disorders, and Gallstone Pancreatitis  American College of Gastroenterology

Leave a Reply

Your email address will not be published. Required fields are marked *