Is Biliary Dyskinesia, true or false?
More than 10% of patients with gallbladder disease have negative ultrasound with no evidence of gall stones. Most of these patients suffer biliary dyskinesia and unfortunately do not get diagnosed for a long time or undergo medical management with little or no response. Biliary dyskinesia is a functional disease of gallbladder which could present with the same signs and symptoms of patients with gall stones. Patients usually present with episodic upper abdominal pain, with or without radiation of the pain to their back or right shoulder and mostly after eating.
These episodes could also be associated with bloating, indigestion and reflux. In these patients with typical signs and symptoms of gallbladder disease, if their ultrasound is normal then we could proceed with CCK stimulated cholescintigraphy or HIDA scan with ejection fraction of gallbladder to evaluate its function. The low ejection fraction of gallbladder in patients with typical signs and symptoms of gallbladder disease is consistent with biliary dyskinesia and removal of gallbladder is indicated. More than 90% of these patients report great response after the surgery.
Other digestive system abnormalities, including acid-peptic disease, functional dyspepsia, or sphincter of Oddi dysfunction could present similar to the gall bladder disease. In some cases, ischemic heart disease also could manifest with similar signs and symptoms. Therefore, the diagnosis of biliary dyskinesia is a diagnosis of exclusion and prior to any surgical intervention the other potential diagnosis needs to be ruled out.