What is Biliary Dyskinesia: Symptoms, Causes, Diagnosis, and Treatment
Definition and Overview
Biliary dyskinesia is a motility disorder that affects the biliary part of the digestive system, which is composed of the gallbladder and the sphincter of Oddi. The disorder, which can affect either of the two said organs, have two different types:
- Gallbladder dyskinesia
- Sphincter of Oddi dysfunction (SOD) – Some gastroenterologists consider SOD as a distinct disease and biliary dyskinesia as its symptom.
The gallbladder is responsible for storing bile that is released by the liver. Normally, the bile passes through the gallbladder and into the small intestine where it is used to help digest fats. However, in patients with biliary dyskinesia, the bile is unable to move through the tubular biliary tract and remains in the gallbladder. As a result, the gallbladder is not able to supply enough concentrated bile for the body to properly digest fats.
This condition is also called acalculous gallbladder disease, which means that it is a gallbladder disease that is not caused by gallstones. Other terms for this disorder include functional gallbladder disorder and impaired gallbladder emptying.
Causes of Condition
Biliary dyskinesia occurs due to the lack of proper muscular coordination in the gallbladder. Doctors are uncertain as to what causes this, but theorise that the following factors may have a role to play:
- Stress – Some evidence shows that stress causes dopamine receptor dysfunction, which can keep the gallbladder from receiving proper signals from the brain.
- A problem with the muscles of the gallbladder
- Excessively tight muscle of the sphincter of Oddi
- Chronic inflammation
- Hormone imbalance
Biliary dyskinesia is also thought to be a symptom of some diseases, such as:
- Celiac disease
- Fibromyalgia – It is common for patients with this condition to also have biliary dyskinesia. Fibromyalgia is characterised by muscle spasms that can also affect the muscles of the gallbladder.
Biliary dyskinesia is more common among females than males, and among patients aged between 40 and 60 years old.
The symptoms of biliary dyskinesia are similar to the usual symptoms of any gallbladder disease, which include:
- Gas or flatulence
- Fever and chills
- Dark urine
- Clay-coloured stools
Other biliary dyskinesia symptoms include:
- Abdominal pain in the right upper area where the gallbladder is located
- Low bile ejection of 33 to 42 percent (which is detected with a HIDA scan)
The pain caused by biliary dyskinesia is similar to that felt by patients with gallstones. Most patients describe it as a sharp pain accompanied by intermittent cramping under the right ribs. It is recurrent, can interfere with the patient’s regular activities, and does not subside even when the patient passes gas, has a bowel movement, or takes antacids. Also, the pain is more commonly experienced early in the morning, during menstruation, or after eating.
Who to See and Types of Treatment Available
Patients who experience the above symptoms can undergo some diagnostic tests including a CCK-HIDA scan, a hepatobiliary scan that checks for the hormone cholecystokinin, which stimulates the contractions of the gallbladder. For the test, the doctor will inject a contrast substance into a vein and into the gallbladder to test how much substance the gallbladder can expel. If it is lower than 40%, then this means that the gallbladder is not functioning properly.
Patients will also need to undergo blood tests, ultrasound scans, a CT scan, or an endoscopic retrograde cholangiopancreatography (ERCP).
Biliary dyskinesia treatment depends on the cause of the condition. If the problem is associated with a pre-existing thyroid issue, then getting treated for thyroid disease may help improve the function of the gallbladder.
Treatment for biliary dyskinesia not related to thyroid problems may include:
- Nonsteroidal anti-inflammatory drugs or NSAIDs
- Prescription pain medications
- Osteopathic treatment
- Supplementation of oral magnesium
- Digestive enzymes
- Biliven or Gallbladder Complex, a broad-spectrum gallbladder formula that promotes healthy bile flow
In severe cases, biliary dyskinesia surgery called cholecystectomy is performed to remove the gallbladder. Nowadays, it is commonly done by inserting a tiny video camera and specialised surgical tools through small incisions in the abdomen. This procedure is called laparoscopic cholecystectomy.
The surgical removal of the gallbladder is effective in relieving biliary dyskinesia pain in up to 90% of cases. In 10% of cases, however, mild symptoms may persist even after surgery. The procedure tends to be more effective among patients whose main symptom is upper right abdominal pain than in patients who mostly experience milder symptoms such as bloating and nausea.
As part of their treatment, patients are advised to reduce stress and to have a special biliary dyskinesia diet to help them lose weight, which could help minimise symptoms. A low-fat, Omega-3 rich diet is known to be helpful for biliary dyskinesia sufferers.
Some doctors prescribe muscle relaxants to prevent stress from affecting the function of the gallbladder or coffee enemas to stimulate the vagus nerve. Some studies also show that drinking 1-2 cups of coffee per day can help improve the gallbladder’s contractions and bile release. Other studies, on the other hand, support the consumption of turmeric (curcumin) as a home remedy for increasing gallbladder production and release.
- Toouli J. “Biliary Dyskinesia.” Curr Treat Options Gastroenterol. 2002 Aug; 5(4): 285-291. https://www.ncbi.nlm.nih.gov/pubmed/12095476
- Thosani AJ. “Acalculous Cholecystopathy.” Medscape. http://emedicine.medscape.com/article/172013-overview
- Heineman K. “Osteopathic manipulative treatment in the management of biliary dyskinesia.” The Journal of the American Osteopathic Association, February 2014, vol. 114, 129-133. http://jaoa.org/article.aspx?articleid=2094718