Biliary dyskinesia is a digestive condition that affects the gallbladder’s ability to empty bile properly. It can lead to considerable discomfort, often presenting with symptoms similar to gallstones, yet without their presence. This condition is becoming increasingly recognized as a cause of gallbladder-related issues, affecting both adults and older children.
Understanding Biliary Dyskinesia
Biliary dyskinesia is considered a functional disorder, meaning the gallbladder itself appears structurally normal, but its function is impaired. The gallbladder, a small, pear-shaped organ located beneath the liver, stores and concentrates bile produced by the liver. Bile is a greenish-yellow fluid essential for digestion, particularly for breaking down fats in the small intestine.
When food, especially fatty meals, enters the small intestine, hormonal signals prompt the gallbladder to contract, releasing bile into the bile ducts and then into the small intestine. In biliary dyskinesia, this coordinated process is disrupted. The gallbladder may not contract effectively, or the small muscle that controls bile flow into the intestine, called the sphincter of Oddi, might not open and close properly. This impaired movement prevents bile from being efficiently ejected, leading to a backup of bile within the gallbladder.
Causes and Contributing Factors
The exact causes of biliary dyskinesia are not fully understood, but several factors are thought to contribute to its development. One primary issue involves abnormalities in the gallbladder’s muscle function, leading to uncoordinated contractions. Problems with the nerves that regulate these contractions or hormonal imbalances, such as fluctuations in estrogen levels, can also play a role.
Dysfunction of the sphincter of Oddi, the muscle controlling bile release into the small intestine, is another potential factor. If this sphincter spasms or fails to open correctly, it can obstruct bile flow, causing symptoms similar to gallbladder problems. Inflammation of the gallbladder (cholecystitis) or underlying metabolic disorders that affect gastrointestinal movement might also be associated with biliary dyskinesia.
Identifying Symptoms and Diagnosis
Individuals with biliary dyskinesia often experience upper right abdominal pain, frequently described as biliary colic. This pain is typically episodic, building to a moderate or severe level and lasting at least 30 minutes, sometimes for several hours. It may occur after eating, especially fatty or rich meals, and can sometimes radiate to the right shoulder or back.
Other common symptoms include nausea, vomiting, bloating, and indigestion. These symptoms can be similar to those caused by gallstones, making differentiation important. Unlike gallstones, however, biliary dyskinesia does not involve physical stones in the gallbladder, which is why diagnosis often requires specific functional testing.
The primary diagnostic tool for biliary dyskinesia is a hepatobiliary iminodiacetic acid (HIDA) scan with cholecystokinin (CCK) stimulation. This imaging test measures the gallbladder’s ejection fraction (EF), which is the percentage of bile it expels during contraction. A radioactive tracer is injected, and CCK is administered to stimulate gallbladder contraction. An ejection fraction below a certain threshold, typically less than 35% or 38%, suggests gallbladder dysfunction. Before this specialized scan, an ultrasound is usually performed to ensure the absence of gallstones or other structural abnormalities.
Treatment Approaches
The most common and effective treatment for biliary dyskinesia is surgical removal of the gallbladder, a procedure known as cholecystectomy. This is often recommended when symptoms are severe and persistent, and a low gallbladder ejection fraction has been confirmed. The surgery is typically minimally invasive, allowing many individuals to return home on the same day.
While surgery provides significant symptom relief for a majority of patients, non-surgical options may be considered for symptom management. These can include dietary modifications, such as adopting a low-fat diet and avoiding trigger foods that exacerbate symptoms. Medications for pain relief, like NSAIDs or antispasmodics, may also be prescribed. However, these non-surgical approaches primarily aim to alleviate symptoms and are generally less effective for definitive resolution compared to gallbladder removal.