Biliary Dyskinesia: Symptoms, Causes & Treatment

Overview

Biliary dyskinesia is a functional disorder that primarily affects the gallbladder's ability to move bile into the bile ducts and occasionally the sphincter where bile enters the small intestine.

• Function of Gallbladder: Stores bile from the liver for digestion; contracts to release bile into the small intestine.
• Dyskinesia Issue: Disruption in hormonal signaling, nerve function, or muscle response causes poor bile ejection and can lead to gallbladder swelling, infections, and pain similar to that caused by gallstones.
• Recognition: Increasingly recognized as a common gallbladder disease affecting both older children and adults, especially in the U.S.
• Risk Factors: Obesity and diabetes may increase risk.

Symptoms and Causes

Common Symptoms

• Upper abdominal pain, especially in the right quadrant.
• Pain episodes lasting up to several hours, not relieved by vomiting or antacids.
• Symptoms after eating, particularly fatty foods.
• Associated symptoms: nausea, vomiting, bloating, unintended weight loss, headaches, fatigue, acid reflux, indigestion, anxiety, and depression.

Causes

• Unknown exact cause; could involve nerve dysfunction or generalized metabolic/motility disorders.

Diagnosis and Tests

Diagnostic Steps

1. Symptom Confirmation: Ensuring the pain is biliary and not due to other abdominal issues.
2. Excluding Other Diseases: Blood tests and abdominal ultrasound to rule out gallstones or other specific biliary diseases.
3. Gallbladder Function Testing: HIDA scan with cholecystokinin to measure bile ejection fraction.
4. Specialized Testing: In rare cases, endoscopic tests for sphincter of Oddi function.

• Criteria for Diagnosis: Biliary dyskinesia diagnosed if gallbladder ejection fraction is less than 40% and not caused by medications or hormones.

Management and Treatment

Treatment Options

• Surgical: Cholecystectomy (gallbladder removal) is the only known effective treatment, usually done minimally invasively.
• Post-Surgery: Adjust diet temporarily to adapt to lack of gallbladder.
• Sphincter Treatment: Endoscopic widening if sphincter dysfunction persists after gallbladder removal.

Post-surgery Side Effects

• Temporary digestive adjustment with recommendations to avoid fatty foods initially.

Outlook / Prognosis

Effectiveness

• Cholecystectomy is 90% effective if diagnostic criteria are met.
• Further testing required if not all criteria are met.

Note

• Biliary colic suggests gallstones, but absence of stones may indicate a functional disorder like biliary dyskinesia.
• Diagnosis is a process; success is likely if the diagnosis is accurate.

Care at Cleveland Clinic

• Specialized digestive care available for adults and children.