From the Guidelines
Gallbladder dyskinesia is diagnosed primarily through a combination of clinical symptoms and functional testing, with a gallbladder ejection fraction less than 35-40% on a hepatobiliary iminodiacetic acid (HIDA) scan with cholecystokinin stimulation being the main diagnostic criterion. The diagnosis of gallbladder dyskinesia, also known as functional gallbladder disorder, involves evaluating patients with upper abdominal pain thought to be biliary in origin who have an ultrasonographically normal appearing gallbladder, as noted in the study by 1.
Diagnostic Criteria
- Gallbladder ejection fraction less than 35-40% on a HIDA scan with cholecystokinin stimulation
- Typical biliary pain symptoms despite the absence of gallstones
- Patients typically present with right upper quadrant pain, nausea, bloating, and fatty food intolerance
Treatment Options
- Conservative approaches including dietary modifications (low-fat diet), pain management, and medications such as prokinetics (metoclopramide 5-10mg before meals), antispasmodics (dicyclomine 10-20mg three times daily), or ursodeoxycholic acid (8-10mg/kg/day)
- Laparoscopic cholecystectomy is the definitive treatment for patients with persistent symptoms and confirmed low ejection fraction, with success rates of 70-90% The pathophysiology of gallbladder dyskinesia involves impaired gallbladder contractility and emptying, which leads to bile stasis and pain from increased gallbladder pressure, as discussed in the context of cholecystokinin-cholescintigraphy in adults by 1. Some patients may have sphincter of Oddi dysfunction contributing to symptoms, which should be considered if symptoms persist after cholecystectomy. Before proceeding to surgery, other causes of abdominal pain should be excluded through comprehensive evaluation including upper endoscopy and abdominal imaging.
From the Research
Diagnostic Criteria for Gallbladder Dyskinesia
- The diagnosis of gallbladder dyskinesia is typically based on symptoms of biliary colic, a normal gallbladder ultrasound, and a gallbladder ejection fraction less than 35% on a cholecystokinin-hepatobiliary scan (CCK-HIDA) 2, 3.
- However, some studies suggest that patients with normal to high ejection fractions may also have gallbladder dyskinesia, particularly if they experience reproducible symptoms during the CCK-HIDA scan 4, 5.
- The Rome III and Rome IV criteria are also used to diagnose functional gallbladder disease, which may be related to gallbladder dyskinesia 4, 5.
Treatment Options for Gallbladder Dyskinesia
- Laparoscopic cholecystectomy is a common treatment for gallbladder dyskinesia, with studies showing improvement or resolution of symptoms in 80-94% of patients 4, 2, 3, 6.
- The effectiveness of cholecystectomy is not solely dependent on the ejection fraction, as some patients with normal to high ejection fractions may also experience symptom resolution after surgery 5, 3, 6.
- Careful patient selection and history-taking are important to distinguish biliary colic from other causes of abdominal pain and to improve surgical outcomes 3.
Subtypes of Gallbladder Dyskinesia
- Biliary dyskinesia can be classified into two subtypes: hypokinesia (ejection fraction less than 35%) and normokinetic biliary dyskinesia (normal ejection fraction with reproducible symptoms during CCK-HIDA scan) 4.
- Normokinetic biliary dyskinesia is a poorly understood condition, but it appears to be associated with chronic inflammation and may be cured by surgical intervention 6.
- Biliary hyperkinesia is another proposed subtype, characterized by an elevated ejection fraction and symptoms of biliary colic 5.