An Overview of Biliary Dyskinesia

Biliary dyskinesia is a condition of the gallbladder. The gallbladder stores a digestive enzyme called bile. Bile is used to help break down ingested fat for proper absorption in the small intestine.

The prefix “dys” means abnormal or not working properly, and “kinesia” refers to movement. Therefore, the term biliary dyskinesia means the abnormal movement of the gallbladder. Specifically, the muscles that squeeze bile out of the gallbladder are not contracting properly. 

Biliary dyskinesia usually affects older children and adults. In some hospitals, it's the number one reason for gallbladder removal procedures.

The numbers are rising. A 2013 study discovered that between the years 1997 and 2010, hospital admissions of those with unknown causes of gallbladder disease tripled. Eighty-one percent of them were said to have biliary dyskinesia.

This article discusses the symptoms and causes of biliary dyskinesia. It also covers how it's diagnosed and treated and what to expect for a prognosis.

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 or based on reports from the patient.

Patients diagnosed with biliary dyskinesia often complain of unexplained pain in the right upper quadrant of the abdomen.

Common symptoms of biliary dyskinesia include:

• Episodic periods of upper right abdominal pain
• 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 by pain)
• Vomiting
• Bloating

Biliary dyskinesia involves symptoms that mimic biliary colic, or pain caused by gallbladder stones. These include:

• 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 gallstones (cholelithiasis).

Causes

The exact cause of biliary dyskinesia is unknown. One possible cause is an underlying metabolic disorder, which affects getting energy from food, from a hormone or enzyme deficiency. This could impact the movement of the gastrointestinal (GI) tract.

Biliary dyskinesia occurs mostly in older children and adults. It is a common diagnosis in children. 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, a long-term condition involving inflammation of the gallbladder.

Diagnosis

Diagnostic criteria are the signs, symptoms, and test results you must have to be diagnosed with a condition. 

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), or other findings that indicate a blockage

When a person has symptoms like those of biliary colic along with a normal ultrasound, additional criteria must be met.

These 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 used to evaluate for biliary dyskinesia.

HIDA Scan

A hepatobiliary iminodiacetic acid (HIDA) scan may be ordered if you meet the diagnostic criteria for biliary dyskinesia. 

A HIDA scan is an 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.

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 other disorder of the upper gastrointestinal tract. Disorders could include stomach or small intestine ulcers, tumors, 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. These include tests of:

• Liver enzymes
• Conjugated bilirubin, a waste product your body gets rid of
• Amylase, an enzyme for digestion
• Lipase, an enzyme that breaks down fats

These labs should all be normal before surgery is considered an option for the treatment of biliary dyskinesia.

Prognosis

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 dependent on factors such as age and overall health. But the research shows that between 50% and 70% continued to have symptom relief a year after the surgery. 

Summary

In biliary dyskinesia, the muscles in the gallbladder don't contract properly when squeezing out bile. Bile is a digestive enzyme that helps break down fat so it can be absorbed in the small intestine.

Symptoms of biliary dyskinesia include pain in the upper right abdomen, pain after eating, intolerance of fatty foods, nausea, and vomiting. Your healthcare provider may suspect biliary dyskinesia based on symptoms and a normal ultrasound of the gallbladder. A HIDA scan and upper endoscopy may be done to help confirm the diagnosis.

For symptoms that don't resolve, your healthcare provider may recommend surgery to remove the gallbladder. Studies show that surgery can be an effective treatment in 80% to 90% of cases.