From the Research
The initial management for gallbladder dyskinesia should prioritize a trial of conservative measures, including dietary modifications and pain management, before considering surgical intervention, as indicated by the most recent and highest quality study 1.
Key Considerations
- Patients should start with dietary modifications, including a low-fat diet and avoiding trigger foods such as fried foods, dairy products, and caffeine.
- Pain management can include over-the-counter medications like acetaminophen or NSAIDs such as ibuprofen.
- For more severe symptoms, antispasmodics like dicyclomine may help relieve biliary colic.
- Some patients may benefit from ursodeoxycholic acid, which improves bile flow and composition.
Conservative Management
- These conservative measures should be tried for 4-6 weeks while monitoring symptom improvement.
- If symptoms persist despite conservative management, cholecystectomy may be considered, particularly in patients with a gallbladder ejection fraction below 35-40% on hepatobiliary iminodiacetic acid (HIDA) scan.
Surgical Intervention
- Cholecystectomy is a viable option for patients with persistent symptoms, as it has been shown to provide relief in a significant proportion of patients, especially those with classic symptoms 2.
- A comprehensive preoperative discussion on expected outcomes needs to take place, as the success of surgery depends on various factors, including the presence of classic symptoms and the gallbladder ejection fraction 1.
Evidence-Based Decision Making
- The decision to proceed with surgical intervention should be based on the latest evidence, including the results of studies such as the one published in 2022 1, which suggests that patients meeting the clinical and diagnostic criteria for gallbladder dyskinesia should be referred for cholecystectomy.
- The use of ursodeoxycholic acid in the management of symptomatic gallstone disease is still a topic of debate, with some studies suggesting its potential benefit 3, but more research is needed to fully understand its effectiveness.