Diagnostic Criteria for Hyperkinetic Gallbladder
The diagnostic criterion for hyperkinetic gallbladder is a gallbladder ejection fraction (GBEF) ≥80% on cholecystokinin-cholescintigraphy (CCK-CS). 1, 2
Definition and Diagnostic Testing
- Hyperkinetic gallbladder, also called hyperkinetic biliary dyskinesia (HBD), is diagnosed using a standardized CCK-CS protocol that measures gallbladder contractility 3
- The test should be performed using a standardized protocol involving infusion of 0.02 μg/kg of sincalide (CCK analog) over 60 minutes 3
- While normal GBEF is defined as ≥38%, hyperkinetic gallbladder is characterized by excessive contraction with GBEF ≥80% 3, 1
- Recent research suggests that an ejection fraction cutoff of 81% is a reasonable upper limit of normal gallbladder function 2
Clinical Context for Testing
- CCK-CS should only be performed in patients with suspected functional gallbladder disorder who meet the Rome III criteria for biliary pain 3
- Testing should be limited to patients with:
- Episodes of right upper quadrant and/or epigastric pain lasting at least 30 minutes
- Recurrent episodes occurring at different intervals
- Pain that builds to a steady level
- Pain severe enough to interrupt activities or lead to medical visits
- Pain not relieved by bowel movements, postural change, or antacids
- Normal liver tests and pancreatic enzymes
- No evidence of gallstones on ultrasound 3
Reporting Considerations
- Despite the prevalence of hyperkinetic gallbladder (36.6% of patients with reported GBEF), only 13.7% of HIDA scans with EF≥80% are explicitly reported as hyperkinetic, with most being reported as "normal" 1, 4
- This underreporting may contribute to underdiagnosis and underrecognition of the condition by treating physicians 1
Diagnostic Pitfalls
- The finding of an abnormal GBEF is not specific for functional gallbladder disorder and may occur in patients with various medical conditions including diabetes, celiac disease, irritable bowel syndrome, or as a result of medications 3
- Medications that can affect GBEF include opioid analgesics, calcium channel blockers, oral contraceptives, H2-receptor antagonists, and benzodiazepines 3
- Patients should be carefully evaluated to exclude other causes for their symptoms before attributing them to hyperkinetic gallbladder 3
- At minimum, serologic testing of liver and pancreatic enzymes and upper endoscopy should be performed before considering CCK-CS 3
Clinical Significance
- Hyperkinetic gallbladder is increasingly recognized as a clinically significant entity that may benefit from surgical intervention 1, 5, 2
- Studies show that 85-95.9% of patients with hyperkinetic gallbladder experience symptom resolution following cholecystectomy 5, 6
- Patients with higher ejection fractions (94% vs 88%) may have better outcomes after cholecystectomy 6
- Chronic cholecystitis is commonly found on pathology (61.7-82.5%) in patients with hyperkinetic gallbladder who undergo cholecystectomy 1, 5, 2
By using a standardized CCK-CS protocol and recognizing the clinical significance of hyperkinetic gallbladder, clinicians can better identify and manage this underdiagnosed condition that significantly impacts patient morbidity and quality of life.