From the Guidelines
Functional gallbladder disorder and biliary dyskinesia are essentially the same condition, with biliary dyskinesia being the more specific term that describes the underlying motility problem. This condition involves impaired gallbladder emptying despite the absence of stones or structural abnormalities.
Key Characteristics
- Symptoms of biliary pain (right upper quadrant or epigastric pain lasting 30+ minutes)
- Normal liver enzymes and imaging studies
- A gallbladder ejection fraction below 38% on hepatobiliary iminodiacetic acid (HIDA) scan with cholecystokinin stimulation, as defined by a standardized protocol involving infusion of 0.02 g/kg of sincalide over 60 minutes 1
Diagnosis and Treatment
Diagnosis typically requires a combination of clinical presentation, laboratory tests, and imaging studies. Treatment options include:
- Dietary modifications (low-fat diet, regular meals)
- Medications (ursodeoxycholic acid, prokinetics like metoclopramide, or smooth muscle relaxants)
- Laparoscopic cholecystectomy for severe cases with documented low ejection fraction, as supported by a randomized controlled study that found cholecystectomy to be effective in improving symptoms in patients with functional biliary pain and a gallbladder ejection fraction <40% 1
Pathogenesis
The condition likely results from abnormal gallbladder motility due to smooth muscle dysfunction, altered cholecystokinin sensitivity, or autonomic nervous system irregularities, which prevent proper gallbladder contraction and bile release into the intestine, as discussed in the context of functional gallbladder disorder and biliary dyskinesia 1
From the Research
Definition and Diagnosis
- Functional gallbladder dysfunction, also known as gallbladder dyskinesia, is characterized by abdominal pain resembling gallbladder pain in the absence of gallstones 2.
- Biliary dyskinesia is a functional gallbladder disorder with an absence of a structural or mechanical cause for biliary pain, often diagnosed using a cholecystokinin-hepatobiliary iminodiacetic acid (CCK-HIDA) scan 3.
- The diagnosis and management of functional gallbladder disorder can be confusing, and there is controversy in the literature regarding the criteria for selecting patients for cholecystectomy 4.
Gallbladder Motility Disorder
- Biliary dyskinesia is typically defined as a gallbladder ejection fraction (EF) of less than 35% on HIDA scan 5.
- Hyperkinetic gallbladder is characterized by an EF of 80% or higher, and its management is not clearly defined 6.
- Some studies suggest that patients with hyperkinetic gallbladder may benefit from cholecystectomy, with reported symptom resolution rates of 95.9% 3 and 100% 6.
Key Differences
- The main difference between functional gallbladder dysfunction and biliary dyskinesia is the presence or absence of gallstones, as well as the gallbladder ejection fraction 2, 4.
- Biliary dyskinesia is often associated with a low gallbladder ejection fraction, while hyperkinetic gallbladder is characterized by a high ejection fraction 5, 6.
- The management of these conditions may differ, with cholecystectomy being a common treatment for biliary dyskinesia, and its role in hyperkinetic gallbladder being less clear but potentially beneficial 3, 6.