From the Guidelines
Hyperkinetic biliary dyskinesia is primarily managed with lifestyle modifications and medical therapy, with cholecystectomy considered in severe cases where the gallbladder ejection fraction exceeds 80% on hepatobiliary iminodiacetic acid (HIDA) scan with cholecystokinin stimulation. The symptoms of hyperkinetic biliary dyskinesia include right upper quadrant pain, often occurring after meals, accompanied by nausea, bloating, and fatty food intolerance 1. Management begins with lifestyle modifications including a low-fat diet, small frequent meals, and avoiding trigger foods. Medical therapy typically involves smooth muscle relaxants such as hyoscyamine (0.125-0.25 mg every 4-6 hours) or dicyclomine (10-20 mg three to four times daily) 1. Prokinetic agents like metoclopramide (5-10 mg before meals) may help some patients.
Diagnosis and Treatment Considerations
- The diagnosis of hyperkinetic biliary dyskinesia typically requires a HIDA scan showing increased ejection fraction (>80%), distinguishing it from hypokinetic biliary dyskinesia where the ejection fraction is reduced (<35%) 1.
- Pain management with acetaminophen or NSAIDs can provide symptomatic relief.
- Antispasmodics should be taken 30 minutes before meals for maximum effectiveness.
- This condition results from excessive gallbladder contractility causing biliary pain despite the absence of gallstones.
- While ERCP and IOC are diagnostic tools for biliary diseases, they are not directly relevant to the management of hyperkinetic biliary dyskinesia, which focuses on symptom control and addressing the underlying motility issue rather than clearing bile duct stones 1.
Key Points in Management
- Lifestyle modifications are the first line of treatment.
- Medical therapy with smooth muscle relaxants and prokinetic agents can help manage symptoms.
- Cholecystectomy may be considered in severe cases with high gallbladder ejection fraction.
- Diagnosis is primarily based on clinical presentation and confirmed by HIDA scan findings.
From the Research
Symptoms of Hyperkinetic Biliary Dyskinesia
- Abdominal pain, particularly in the right upper quadrant, is a common symptom 2, 3, 4, 5, 6
- Other symptoms may include nausea, vomiting, back pain, and epigastric pain 3, 6
- Symptoms can be intermittent and may not always be accompanied by gallstones or other structural pathology 3, 4, 5
Management Options for Hyperkinetic Biliary Dyskinesia
- Laparoscopic cholecystectomy is a common treatment option for hyperkinetic biliary dyskinesia, with studies showing significant improvement in symptoms after surgery 2, 3, 6
- Cholecystectomy has been shown to result in resolution of symptoms in a high percentage of patients, regardless of the presence of gallstones 2, 3, 6
- The use of cholecystectomy for hyperkinetic biliary dyskinesia is reasonable based on available data, although large-scale prospective studies are needed to address knowledge gaps surrounding this diagnosis 5
- Patients with hyperkinetic biliary dyskinesia may also have underlying chronic gallbladder inflammation, which can be diagnosed through pathology after cholecystectomy 2, 3, 6