An Overview of Biliary Dyskinesia

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Biliary dyskinesia is a condition of the gallbladder. The gallbladder stores a digestive enzyme called bile. The prefix “dys” means abnormal or not working properly, and “kinesia” refers to movement. Therefore, the word, biliary dyskinesia means the abnormal movement of the gallbladder, most commonly because the muscles that squeeze bile out of the gallbladder are not contracting properly. 

The condition usually affects older children and adults. In some hospitals, biliary dyskinesia is the number one reason for gallbladder removal procedures. The numbers are rising. In fact, a 2013 study discovered that between the years of 1997 and 2010, hospital admissions of those with unknown causes of gallbladder disease81% of which were said to have biliary dyskinesiatripled.

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What is the Biliary Tract?

The biliary tract (also referred to as the biliary tree or biliary system) is a system of tubular structures (called bile ducts) that lead from the liver to the gallbladder and eventually the small intestine. The bile ducts are located inside and outside the liver. These ducts work to move bile from the liver (where the bile is made) into the first section of the small intestine (duodenum) where bile is used to help break down ingested fat for proper absorption. Bile is made up of water, electrolytes, bile acids, cholesterol, phospholipids and conjugated bilirubin.

Symptoms

Biliary dyskinesia is considered a functional disorder. This means that normal functioning of the body—in this case, normal digestion—is disrupted. Under medical examination, there does not appear to be any abnormality, therefore, symptoms are largely subjective (symptoms that are reported by the patient).

The exact cause of biliary dyskinesia is not well known. But it is a common condition that is diagnosed when a person—seeking medical attention—complains of unexplained pain in the right upper quadrant of the abdomen.
Other common symptoms of biliary dyskinesia include:

  • Episodic periods of abdominal pain (located in the right upper quadrant)
  • Abdominal pain that occurs after eating
  • Intolerance of fatty foods
  • Pain that is severe enough to limit a person’s daily activities
  • Nausea (that is accompanied with the bouts of pain)
  • Vomiting
  • Bloating

Biliary dyskinesia involves symptoms that mimic biliary colic, including:

  • Sharp pain in the upper right quadrant of the abdomen (that may radiate [travel] to the right shoulder
  • Pain that may be sudden or that may come and go over an extended time span
  • Nausea and vomiting
  • Lack of appetite (common in children)

Note: The symptoms that mimic biliary colic must not be caused by gallbladder stones (cholelithiasis).

Causes

The exact cause of biliary dyskinesia is unknown. It is thought that a possible cause could be an underlying metabolic disorder (such as a hormone or enzyme deficiency) that impacts the movement of the gastrointestinal (GI) tract.

Biliary dyskinesia occurs mostly in older children and adults. It is a common diagnosis in children; in fact, in some pediatric hospitals, biliary dyskinesia has become the most common reason for gallbladder removal.

Biliary dyskinesia is sometimes associated with a condition called cholecystitis, which is a long-term condition involving inflammation of the gallbladder.

Diagnosis

Diagnostic criteria are defined as the signs and symptoms (as well as lab and other test results) that a person must have, in order for a diagnosis of a specific disorder or disease to be made. The diagnostic criteria for biliary dyskinesia include:

  • Right upper quadrant pain in the abdomen
  • Normal ultrasound of the gallbladder—without gallstones, sludge (a collection of bilirubin, calcium, and cholesterol that builds up when bile stays in the gallbladder too long), gallbladder wall thickening (usually caused by an obstruction) or significant common bile duct (CBD) dilatation (caused by stones, tumors or other obstructive process)

When a person has symptoms like those of biliary colic, and presents with a normal ultrasound, additional criteria (called the Rome III diagnostic criteria) must be met.

The Rome III diagnostic criteria include:

  • Episodes of pain lasting more than 30 minutes
  • Symptoms that come and go, occurring at erratic intervals
  • Pain that disrupts normal daily activities or is so severe that a person seeks emergency medical care
  • Pain that gradually becomes continual
  • Pain that is unrelieved by interventions (such as changing positions or taking antacids)
  • Symptoms that are not caused by another condition (such as appendicitis)
  • Normal lab results (such as liver enzymes, bilirubin and amylase and lipase levels)

Diagnostic Tests

There are two diagnostic tests that may be employed to evaluate for biliary diskinesia.

HIDA Scan

A diagnostic test called a hepatobiliary iminodiacetic acid (HIDA) scan may be ordered when the ROME III diagnostic criteria have been met in a person with a normal ultrasound. A HIDA scan is a medical imaging procedure involving a radioactive tracer that is injected into a vein in the arm. The tracer travels to the liver, where the liver’s bile-producing cells take up the tracer. Next, the tracer travels into the gallbladder through the bile ducts. Computer images are taken, as a nuclear medicine scanner tracks the flow of the tracer from the liver, into the gallbladder, then finally, into the small intestine. A HIDA scan is used to evaluate for gallbladder abnormalities when no gallstones are seen on ultrasound.

Upper Endoscopy

An upper endoscopy is a procedure that is usually performed on an outpatient basis. It involves the use of a flexible tube with a camera (inserted through the mouth) to view the upper digestive system. This diagnostic procedure may be used before gallbladder removal to confirm that the patient's symptoms are not caused by some type other disorder of the upper GI tract, such as stomach or small intestine ulcers (called gastric/duodenal ulcers), a tumor, other structural disorders of the upper digestive tract, or gastroesophageal reflux disease (GERD).

Treatment

The treatment of biliary dyskinesia is removal of the gallbladder, also called a cholecystectomy. Some experts suggest that a cholecystectomy should not be performed if a person has been having symptoms for less than three months.

Before a cholecystectomy is performed, every person with symptoms of biliary dyskinesia should have complete lab studies, including liver enzyme studies, conjugated bilirubin, amylase, and lipase levels. These labs should all be normal before surgery is considered an option for the treatment of biliary dyskinesia.

Prognosis

The prognosis is an estimate (based on clinical research studies) of how well the outcome of a specific procedure or treatment can be expected. Studies have shown that cholecystectomy was effective in the treatment of 80 to 90% of those with biliary dyskinesia. A year after cholecystectomy, ongoing symptom relief was found to be very dependent on factors such as age, overall health and more. But the research shows that between 50% to 70% continued to have symptom relief a year after the surgery. 

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