What Is Biliary Dyskinesia?

Medically reviewed by Robert Burakoff, MD

Biliary dyskinesia is a functional disorder that occurs when your gallbladder (a small pear-shaped organ that stores and processes) can't contract and release bile effectively. Bile is important for the digestion and absorption of fats in the small intestine. Biliary dyskinesia affects about 10%-20% of adults globally.

Common symptoms of this condition include pain in the upper right abdomen that lasts for about 30 minutes, nausea, vomiting, and sweating. Fortunately, treatments are available to help relieve symptoms. A cholecystectomy, or the surgical removal of your gallbladder, is usually the most effective treatment option. However, medications can provide temporary symptom relief.

Biliary Dyskinesia Symptoms

The symptoms of biliary dyskinesia often mimic the symptoms of biliary pain, which usually occurs if you develop gallstones. If you have biliary dyskinesia, you may experience one or more of the following symptoms:

• Upper right-side abdominal pain

• Excessive sweating

• Stomach pain after eating a meal

• Nausea and vomiting

• Pain that does not improve with posture changes, bowel movements, or taking antacids

Abdominal pain is the most common symptom of this condition. Abdominal pain gradually increases in severity and reaches a peak that lasts for about 30 minutes. After a few hours of this peak pain, symptoms slowly start to improve. However, abdominal pain happens in episodes, meaning that you'll likely experience pain again later in the day or the next day.

Causes

The exact cause of biliary dyskinesia is unknown. One possible cause is an abnormality in the smooth muscle layer of the gallbladder that affects how your gallbladder contracts and empties out bile.

Researchers also suspect that biliary dyskinesia may occur due to common gastrointestinal motility disorders (or, conditions that make it hard for nerves or muscles to contract and relax properly) such as:

• Achalasia: A swallowing disorder in which esophagus muscles can't move food toward your stomach effectively

• Scleroderma: An autoimmune condition that thickens skin and tissues

• Gastroparesis: Delayed emptying of your stomach due to altered stomach muscle function

• Constipation: Having fewer bowel movements than normal (generally fewer than three per week)

• Hirschsprung disease: Lack of nerves in your colon (large intestine), which affects motility and bowel movements

Diagnosis

Abdominal pain can occur due to other gastrointestinal conditions (like bile duct obstruction, inflammatory bowel disease, or peptic ulcer disease), so healthcare providers use a specific set of diagnostic criteria to determine if your symptoms are due to biliary dyskinesia. The diagnostic criteria for biliary dyskinesia include:

• Pain that lasts for 30 minutes or longer

• Pain that occurs in intervals or episodes

• Pain that interferes with daily activities or requires an emergency room visit

• Pain that does not improve after bowel movements, postural changes, or antacids

• Pain that occurs with nausea and vomiting

• Absence of gallstones or other deposits that may be blocking the flow of bile

• Normal levels of liver enzymes, pancreatic enzymes (amylase or lipase), and conjugated bilirubin (a substance found in bile, a liver fluid that helps digestion)

Testing

Once your provider learns more about your symptoms and performs a physical exam, they'll order two tests to confirm if you have biliary dyskinesia:

• Endoscopic ultrasound: This procedure uses an endoscope (a thin, flexible tube with a light and a camera at one end) which sends off high-energy ultrasound waves to visualize your internal organs. It can detect the presence of structural causes of biliary pain such as gallstones or gallbladder inflammation.

• Hepatobiliary iminodiacetic acid (HIDA) scan: This procedure involves injecting a radioactive tracer directly into your vein. The tracer flows through your bloodstream, mixes with bile in your liver, and flows through a series of ducts into your gallbladder and small intestine. The HIDA scan determines how well your gallbladder contracts by measuring the percentage of radioactive tracer released from your gallbladder over time.

The HIDA scan can help your provider understand any irregularities in your gallbladder contraction, which helps confirm a biliary dyskinesia diagnosis. In some cases, healthcare providers administer cholecystokinin (a hormone that stimulates the release of bile) to trigger gallbladder contraction and release of bile (ejection fraction). An ejection fraction of less than 40% may be a sign of biliary dyskinesia.

Biliary Dyskinesia Treatment

A laparoscopic cholecystectomy (surgical removal of the gallbladder) is the most common treatment for biliary dyskinesia. This surgery makes small cuts in your abdomen and is usually safe. You can typically go back home on the same day of the surgery and return to your regular activities within a week. Temporary side effects such as diarrhea or bloating can occur after the surgery.

In some cases, healthcare providers may recommend certain medications—for example, non‐steroid anti‐inflammatory (NSAID) drugs such as Mobiflex (tenoxicam), Voltaren (diclofenac), and Toradol (ketorolac) for pain relief.

Prevention

The cause of biliary dyskinesia isn't currently known, so researchers don't exactly know how to prevent the condition from occurring. However, healthcare providers recommend the following habits to improve and maintain your gastrointestinal health:

• Eating a high-fiber diet

• Avoiding oily and spicy foods

• Drinking 8 to 10 glasses of water daily

• Participating in regular exercise or physical activity

Complications

If left untreated, biliary dyskinesia can lead to complications that can negatively affect your health. These include:

• Cholecystitis: Gallbladder inflammation that can occur due to lack of flow of bile in the gallbladder

• Gallstones: Improper gallbladder emptying that results in gallstone formation

• Recurrent pain: Impaired gallbladder contraction that can lead to ongoing pain

• Infection: Lack of bile flow in the liver that can cause growth of bacteria, eventually leading to infections

Living With Biliary Dyskinesia

Abdominal pain can cause significant discomfort. See a healthcare provider for diagnosis and treatment if you're experiencing symptoms. They can help you determine what's causing your pain and recommend a treatment plan to relieve symptoms.

Fortunately, 90% of people who receive a cholecystectomy notice that symptoms go away after the procedure. Following general wellness guidelines like eating nutritious foods and drinking water can also help improve your gastrointestinal health.

Frequently Asked Questions

Does a low-functioning gallbladder need to be removed?

A low-functioning gallbladder may occur if you have gallstones, gallbladder inflammation, and gallbladder infections. Surgical removal of the gallbladder can help improve symptoms, but your provider will only recommend surgery if it is safe for you.

How serious is biliary dyskinesia?

Biliary dyskinesia can progress into a serious condition and negatively affect your quality of life due to recurrent abdominal pain, trouble sleeping, and difficulty performing your daily activities. If you have symptoms, it's best to contact your healthcare provider to get treatment and avoid complications.

Can biliary dyskinesia go away on its own?

Biliary dyskinesia rarely goes away on its own. That's why seeing your healthcare provider for treatment is crucial.

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