Normally, the gallbladder and bile ducts work together to allow bile to flow into the intestines for digestion. When this flow of bile is interrupted, a painful condition called biliary dyskinesia can result.
What is biliary dyskinesia?
Your biliary system is the part of the digestive system that is involved in moving bile. Bile is made in the liver and then flows continuously into the small intestine. A small amount is also stored in the gallbladder. After a fatty meal, the gallbladder contracts to squeeze this extra bile through the ducts and into the intestine to aid in digestion.
Biliary dyskinesia is a disorder of the gallbladder and bile ducts. The most common problem occurs when the gallbladder does not contract the way that it should when stimulated. Pain and nausea can result. When the problem is from the gallbladder, it is also known as gallbladder dysmotility.
A second cause of biliary dyskinesia can be from the bile ducts themselves. A trio of muscles at the end of the bile duct helps regulate the flow of bile into the intestine and is known as the sphincter of Oddi. When this muscle goes into spasm and contracts abnormally it blocks the flow of bile and pressure builds up. This can also cause the same symptoms of pain and vomiting and is also called sphincter of Oddi dysfunction.
Most cases of biliary dyskinesia are not associated with gallstones. People who have pancreatitis may also suffer from it. This condition may also be related to a problem with the hormone cholecystokinin, which stimulates the flow of bile. Biliary dyskinesia is very common. In some communities, gallbladder removal to treat its symptoms is more common than to treat gallstones.
Symptoms of biliary dyskinesia
The most common symptom of this condition is abdominal pain. It will most likely be concentrated in the upper right-hand side of the abdomen and can radiate to the flank or back. It may be worse after a large meal or after eating fatty foods. You may also experience bloating, nausea and vomiting.
Diagnosing biliary dyskinesia
Symptoms can be similar or even exactly mimic gallstone type disease. Ultrasound is important, but may not show anything abnormal. Pain after eating fatty foods is key, and should usually lead to performing a nuclear medicine test known as a HIDA scan with gallbladder ejection fraction, or HIDA with GBEF. In this test, the function of the gallbladder is measured as it is stimulated with either a fatty meal or by the injection of cholecystokinin (CCK) to cause gallbladder contraction. If the gallbladder does not empty properly, or if symptoms occur, the test is positive for dysmotility. The same is true if bile doesn’t flow properly into the intestine. These tests and clinical suspicion from your surgeon are usually needed to make the diagnosis.
Biliary dyskinesia treatment
The only effective treatment for biliary dyskinesia is removal of the gallbladder, usually be minimally invasive or laparoscopic surgery. If symptoms don’t fully resolve, then an operation on the sphincter of Oddi called a sphincterotomy to cut the muscle and prevent spasm is effective.