Biliary Dyskinesia, or Low-Functioning Gallbladder

Biliary Dyskinesia

Biliary dyskinesia is a gallbladder condition in which the gallbladder has a lower-than-normal function (below 33%). It is classified as a motility disorder that affects the gallbladder as well as the sphincter of Oddi. It is also called acalculous gallbladder disease which basically means a problem with the gallbladder in the absence of gallstones. Other terms are functional gallbladder disorder or impaired gallbladder emptying.

Biliary Dyskinesia is frequent in children complaining of biliary colic – upper right abdominal pain, nausea, vomiting, and intolerance to fatty foods. However, it often goes undiagnosed.

Symptoms Of Biliary Dyskinesia

  • gallbladder attacks in the absence of gallstones
  • right upper abdominal pain after eating
  • gas, bloating, burping, nausea, vomiting, fat intolerance and any or all other symptoms of gallbladder disease and colic

 

Diagnosis Of Biliary Dyskinesia

To be diagnosed with Biliary Dyskinesia, the patient must have no stones, no sludge, no microlithiasis (tiny stones), and no thickening of the gallbladder wall, although there is some consensus that a low-functioning gallbladder can be a contributing factor to the formation of gallstones as the bile is allowed to stagnate within the gallbladder.

Diagnosis is done via a HIDA scan. HIDA stands for hepatobiliary iminodiacetic acid scan, also called cholescintigraphy or hepatobiliary scintigraphy. Radio-active dye is used to follow the path of the bile from the liver, into the gallbladder and from the gallbladder to the small intestine.

A measurement is made of the amount of bile that is ejected from the gallbladder when it is induced with CCK (gallbladder stimulating hormone). A healthy gallbladder never ejects 100% of its bile; in fact, over 75% ejection is considered a pathology as well and is called biliary hyperkinesia. A normal ejection fraction is between 33-42%. A low ejection fraction would be 32% or lower. It is interesting to note that people with a 16% ejection fraction can experience more symptoms than someone with 3% or 0%.

Causes Of A Low-Functioning Gallbladder

  • chronic, ongoing inflammation causes gallbladder wall thickening which is less efficient at contraction
  • stress
  • hypothyroidism

 
Natural Support For Biliary Dyskinesia

  • Checking thyroid function with a functional doctor and getting treatment for thyroid, if called for, may help to increase gallbladder functioning. Learn about the connection between hypothyroidism and gallbladder disease.
  • Reducing stress including herbal muscle relaxants
  • Coffee enemas for stimulating the vagus nerve
  • Drinking 1-2 cups of coffee daily is shown to increase gallbladder contraction and CCK release.1.
  • Curcumin from turmeric has been shown to increase gallbladder contractions, gallbladder emptying and gallbladder refilling
  • The Gallbladder Starter Kit for thinning and moving the bile, supporting digestion and biliary flow along with following a Healthy Gllbladder Diet

 

Hyperkinetic Biliary Dyskinesia, Or Biliary Hyperkinesia

A hyperkinetic gallbladder is a motility disorder in the opposite direction activity of biliary dyskinesia - one that is overactive. Symptoms of biliary hyperkinesia can be a cause for pain and attacks and may include any or all signs of biliary colic - pain in the right upper quadrant of the abdomen, especially after a meal, nausea, vomiting, bloating, fatty food intolerance and the main differential – in the absence of gallstones. An ejection fraction of over 75% (some say 65%) is the determines this diagnosis.
 

Causes Of Biliary Hyperkinesia

Essentially the gallbladder is hyper-functioning and perhaps going into spasms. Some studies have shown increased receptor sites to cholecystokinin or CCK which is the hormone that causes gallbladder contraction. They also hypothesize increased secretion of CCK.

The standard medical treatment for biliary hyperkinesia at the moment is laparoscopic cholecystectomy.

Natural methods of support include anti-spasmodic herbs such as Cramp Bark, castor oil packs for reducing inflammation, stress support including B vitamins, adaptogenic herbs and herbs with natural relaxant properties.
 

Research:

Is bile flow reduced in patients with hypothyroidism? JohannaLaukkarinenJuhaniSandRauniSaaristoJormaSalmiVäinöTurjanmaaPenttiVehkalahtiIstoNordbackMD (Surgery 2003;133:288-93)

"Further, gallbladder emptying assessed by CCK-cholescintigraphy may not be a sensitive test that predicts a benefit from cholecystectomy. Certainly cholecystectomy (gallbladder removal) for dyspeptic complaints of gassiness, bloating, indigestion and fatty food intolerance is disappointing. Despite the Rome III consensus, the literature does not yet support cholecystectomy being done routinely for biliary dyspepsia."2.

Curcumin is easily absorbed through the digestive tract and is eliminated through the bile ducts. Curcumin passes through the liver, increasing the output of bile, and frequently, emptying of the gallbladder. Its action is both choleretic and cholagogue. (This doctor used curcumin in cases of chronic gallbladder disease.)

  1. Coffee stimulation of cholecystokinin release and gallbladder contraction in humans.B R Douglas,J B Jansen,R T Tham, and C B Lamers,The American Society for Clinical Nutrition, September 1990 vol. 52 no. 3 553-556
  2. Biliary Dyspepsia: Functional Gallbladder and Sphincter of Oddi Disorders, Meena Mathivanan, Liisa Meddings and Eldon A. Shaffer- 2013 - cdn.intechopen.com
    3.Turmeric (curcumin)in Biliary Diseases, Albert Oppenheimer,The Lancet, Volume 229, Issue 5924, 13 March 1937, Pages 619–621

Add the following studies:

The effect of curcumin and placebo on human gall-bladder function: an ultrasound study

A Rasyid, A Lelo - Alimentary Pharmacology and Therapeutics, 1999

Curcumin induced gallbladder contraction

 

Therapeutic roles of curcumin: lessons learned from clinical trials

SC Gupta, S Patchva, BB Aggarwal - The AAPS journal, 2013 – Springer

Relieved pain of BD in 3 weeks

Relieved subjects of cholecystitis in 3 months at 250 mg a day

Oppenheimer A. Turmeric (curcumin) in biliary diseases.
Lancet. 1937;229:619–621. doi: 10.1016/S0140-6736(00)98193-5.

 

Biliary dyskinesia: a potentially unrecognized cause of abdominal pain in children

BT Campbell, NP Narasimhan, ES Golladay… - Pediatric surgery, 2004