From the Guidelines
A hyperkinetic gallbladder is a functional disorder characterized by increased gallbladder contractility and emptying, which can cause biliary-type pain similar to gallstones despite the absence of stones or structural abnormalities, and diagnosis typically requires a hepatobiliary iminodiacetic acid (HIDA) scan showing an ejection fraction greater than 65-80%.
Diagnosis and Treatment
The diagnosis of a hyperkinetic gallbladder is primarily based on the results of a HIDA scan, which measures the gallbladder's ability to contract and empty 1.
- The treatment begins with dietary modifications, including small, frequent, low-fat meals to reduce gallbladder contractions.
- Medications that may help include antispasmodics like dicyclomine (10-20mg three to four times daily) or hyoscyamine (0.125-0.25mg every 4 hours as needed), and smooth muscle relaxants such as calcium channel blockers like nifedipine (10-20mg three times daily) 1.
Considerations for Surgery
For persistent symptoms, cholecystectomy (surgical removal of the gallbladder) may be considered, though success rates are lower than for gallstone disease, ranging from 60-80%.
- The condition results from dysregulation of gallbladder motility, possibly due to altered cholecystokinin sensitivity or autonomic nervous system dysfunction.
- Patients should understand that this is a functional disorder that may improve with conservative management, and surgery should be considered only after failed medical therapy 1.
Clinical Considerations
It is essential to note that the provided evidence, including studies from 1993 1, may not directly address the diagnosis and treatment of a hyperkinetic gallbladder, but the most recent and relevant study 1 provides the best guidance for clinical practice.
- The American College of Physicians guidelines for the treatment of gallstones may not be directly applicable to the management of a hyperkinetic gallbladder, but they do emphasize the importance of considering the patient's preferences and the potential risks and benefits of different treatment options 1.
From the Research
Diagnosis of Hyperkinetic Gallbladder
- A hyperkinetic gallbladder is typically defined as a gallbladder ejection fraction (EF) ≥ 80% on a hepatobiliary iminodiacetic acid (HIDA) scan 2, 3, 4, 5
- The diagnosis of hyperkinetic gallbladder is often underrecognized, with only 13.7% of HIDA scans with EF ≥ 80% being reported as hyperkinetic 2
- Patients with hyperkinetic gallbladder may present with symptoms such as biliary colic, right upper quadrant pain, and chronic cholecystitis 2, 3, 4, 5
Treatment of Hyperkinetic Gallbladder
- Cholecystectomy is a common treatment for hyperkinetic gallbladder, with most patients experiencing symptom improvement after surgery 2, 3, 4, 5
- Minimally invasive cholecystectomy is often used to treat hyperkinetic gallbladder, with a high success rate in resolving symptoms 2, 3, 4
- The role of medical management in treating hyperkinetic gallbladder is not well established, but some studies suggest that certain medications such as cholecystokinin, caerulein, and motilin may stimulate gallbladder contraction 6
- Patients with hyperkinetic gallbladder who undergo cholecystectomy may have a higher incidence of chronic cholecystitis on final pathology reports 2, 4
Outcomes of Treatment
- Studies have shown that cholecystectomy can lead to significant symptom improvement in patients with hyperkinetic gallbladder, with symptom resolution rates ranging from 89% to 95.9% 2, 3, 4, 5
- Patients who undergo cholecystectomy for hyperkinetic gallbladder may have better outcomes compared to those managed nonoperatively, with lower rates of alternate diagnoses, medication prescriptions, and emergency department visits 5