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Biliary Dyskinesia–Remove or Not Remove the Gallbladder?

Author: Peter Melamed, PhD

Many people, including children, can experience attacks of colicky pain in the right upper quadrant (RUQ) of their abdomens. This type of abdominal pain may also radiate to the upper back or right shoulder blade. Usually, it occurs after eating fatty or fried foods and/or heavy meals. Commonly, it is accompanied by nausea, vomiting, bloating, followed by loose stool. This condition has a medical term—”functional gallbladder disorder” or “biliary dyskinesia“.  2 to 5 percent of adults and up to 10 percent of children can can experience this condition . [3]  Up to now, this is a huge crowd of potential candidates for the removal of the gallbladder.

Typically, even when a person has all of these symptoms, blood and imaging test results can come back normal. Doctors would interpret these results and diagnose an individual with biliary dyskinesia. “Biliary” means bile, “dys” means irregular, and “kinesia” implies movement, motion, in Latin. Biliary Dyskinesia is the abnormal movement of bile:

  • in the gallbladder,
  • in bile ducts,
  • inside and outside the liver,
  • in the sphincter of Oddi, and
  • between the common bile duct and the duodenum.

In medical articles, scientists consider biliary dyskinesia and the sphincter of Oddi dysfunction (SOD) type III to be similar conditions. However, there is no consensus among doctors, gastroenterologists, and surgeons about this diagnosis or even the name of the functional disorders of the gallbladder and biliary system. Therefore, this condition is also referred to as functional gallbladder disorder, acalculous biliary disease, acalculous cholecystopathy, or chronic acalculous cholecystitis. “Acalculous” means “no stones.” More diagnostic names that can be given are gallbladder dysfunction, gallbladder dyskinesia, spasm of the sphincter of Oddi, sphincter of Oddi dysfunction, low-functioning gallbladder, gallbladder spasm, chronic acalculous gallbladder dysfunction, or cystic duct syndrome. As you can see, there are many different viewpoints on biliary dyskinesia.

Biliary dyskinesia can be subdivided into the hyperkinetic (the high contractile activity of the biliary system causing spasms), and hypokinetic (the low contractile activity, low motility of the gallbladder and sphincter of Oddi). Hyperkinetic biliary dyskinesia is more common in teens and young adults. In contrast, hypokinetic dyskinesia occurs more in people over forty years of age. It develops in individuals who suffer from mental instability.

Most people suffering from biliary dyskinesia complain of multiple nervous symptoms. They experience a high level of fatigue, depression, anxiety, bouts of tearfulness and irritability, heart palpitations, sweating, and recurrent headaches. And not to forget…people also can experience pain in the RUQ.

If one has hyperkinetic dyskinesia, the pain is a colicky type or spasmodic. The pains are sharp and last for short periods. Pain can irradiate to the right shoulder or the shoulder blade. Often, such attacks occur after consuming fatty foods, sugar, alcohol, or while a person is under a high level of stress, both physically and emotionally. For women, hyperkinetic dyskinesia can occur during menstruation. Frequently, individuals with hyperkinetic biliary dyskinesia taste bitterness in their mouths, usually in the morning.

If someone is suffering from hypokinetic biliary dyskinesia, this is characterized by constant, dull, and aching pain, along with a feeling of fullness in the RUQ. Appetite is markedly low, and a person is often sick and nauseous. Belching and burping can also occur. This type of biliary dyskinesia alters the motility of other gastrointestinal organs: the colon, which leads to constipation, the stomach, which leads to gastroparesis, and the esophagus, which leads to achalasia.[9]

Biliary dyskinesia may last a long time, and severe periodical exacerbations can flare up. Unhealthy eating habits, stress, alcohol, some medications, and hormonal changes provoke a worsened state.

The excess buildup of pressure in the bile ducts or irritation is thought to be accountable for these typical biliary dyskinesia symptoms. Unfortunately, there are many other reasons, as we noted in the early such as changes in the biochemistry of the bile. Very often, it can be a setback with proper regulation of the digestive organs.

Besides what we have already noted, some parasites that are difficult to find and reside in the gallbladder and bile ducts are responsible for biliary dyskinesia. For example, Giardia lamblia and flukes can be responsible for some cases of biliary dyskinesia and sphincter of Oddi dysfunction type III, especially in children.

Other culprits can also be high whole-body acidity levels, hepatitis, fatty liver, Candida-yeast overgrowth, congestion, inflammation, infection, and poor eating habits. They can cause bile to be thick, acidic, and very aggressive. Thick, thick bile is hard to move through the ducts. Toxic substances in bile, parasites, irritation, and food allergies can restrain the proper motion of the gallbladder, bile ducts, and sphincter of Oddi.

Whole-body acidity can change bile’s pH. The presence of extremely aggressive bile acids and acidic bile irritate the gallbladder, bile ducts, the sphincter of Oddi, and the duodenum causing spasmodic contractions with pains. Aggressive, acidic bile hurts the small intestine and even the stomach, causing heartburn, nausea, and vomiting. Our E-book “Healthy Pancreas, Healthy You,” discusses whole-body acidity and helps those who struggle with it.

If tests reveal no structural defects and there are no severe inflammations or gallstones, biliary dyskinesia is often misdiagnosed as functional dyspepsia, stomach flu, IBS, acid reflux, psychosomatic diseases, etc. When patients are given symptomatic medications, they modify or cover the symptoms. More specific tests can show low ejection fraction (EF) that shows low gallbladder function. If an EF result is <35%, it is considered to be abnormal. When specific tests reveal that a person has a low ejection fraction, they are typically referred to a surgical consultation for gallbladder removal. So, the question remains…

To remove or not remove the gallbladder in the case of biliary dyskinesia.

Our answer is, “No.” Biliary dyskinesia is not a surgical problem because it is a functional disorder. In this situation, all efforts need to focus on why the organ is working so low. Finding and eliminating the triggers can improve the function of the gallbladder.

A big, valid concern is the removal of the gallbladder in small children, teenagers, and young adults. Currently, there is no medical research or data available to know about the long-term consequences of gallbladder removal. How will young people without a gallbladder feel in 20 years?

Many medical papers are aware of the postcholecystectomy syndrome, and medical data reveals that this syndrome consists of constant pain and indigestion symptoms. A range of indigestion symptoms includes gas, bloating, bile reflux, intolerance of fatty foods, and bile-acid diarrhea. These symptoms can make the life of anyone without gallbladder miserable.

Since Western Medicine has so many viewpoints on biliary dyskinesia, as we found with the plethora of different names that are used just for diagnosis, how does one know with certainty if a patient has the functional dyspepsia or biliary dyskinesia? If Western Medicine has a hard time distinguishing between the two, then maybe drastic treatment measures are not appropriate. Find the root of the problem before removing an organ via surgery.

A death sentence for the gallbladder comes with the result from a particular imaging test–Cholescintigraphy–also called a HIDA scan. This test shows the gallbladder ejection fraction (GBEF). Patients with a GBEF of less than 35 to 40 percent are considered to have abnormal gallbladder motility. Let’ stop here for a moment. This test is not 100% correct. Even radiologists think that positive predictive values from the HIDA scan will likely be lower, and the false-positive rate will probably be higher.[1]

Another medical study revealed 27% and 10% false-positive rates in healthy volunteers. Many, many factors can cause gallbladder and biliary disorders, and all of this can influence gallbladder motility. Some severe underlying illnesses or medications can promote false-positive results. Such diseases include diabetes, trauma, IBS, liver cirrhosis, medications like opioids painkillers, NSAID, some antibiotics, birth control pills, etc. The HIDA scan remains a highly debated tool as a marker for gallbladder removal.[2]

Another medical paper also shows that false-positive results can be seen with diabetes, obesity, cirrhosis, celiac disease, and several medications, including calcium-channel blockers, histamine-2 receptor antagonists, atropine, octreotide, oral contraceptives/progesterone, opiates, benzodiazepine, and theophylline.[3] Changes in women’s hormones during puberty, pregnancy, menopause, or from birth-control pills contribute to the prevalence of gallstones and biliary motility disorders.[4]

Other digestive organs may have low motility. Motility means movement through the GI tract. Dysmotility is a condition in which the smooth muscles of the digestive system become impaired and change in speed, strength, or coordination. The motility disease affecting the esophagus is known as achalasia, or low stomach motility calls gastroparesis. The low motility of the colon produces constipation. There is dysmotility of the small intestine as well. In all of these situations, surgeons do not remove the esophagus, stomach, or colon simply because their movement is slow. Instead of removing these organs, doctors try to find the reasons for the dysmotility and improve it. [5, 6]

If you are sent to the surgeon for the consultation about your RUQ pain and biliary dyskinesia, the verdict will be “You need surgery.” But let’s review the medical information about this subject. Generally, the articles, which support the cholecystectomy in a case of biliary dyskinesia wrote by surgeons for surgeons or those in the health industry who promote surgery. But the situation is not so simple and joyful. The primary goal of gallbladder removal surgery is to diminish pain. However, 10-30 percent of patients after gallbladder removal continue to suffer from pain. The cholecystectomy did not stop the digestive symptoms such as an intolerance to fatty foods, gas, bloating, stubborn heartburn, diarrhea, etc.

In 2014, the journal “Digestion” published an article “Gallbladder Dysfunction: How Much Longer Will It Be Controversial?” A group of American surgeons and doctors wrote a medical review of this topic. Here are some quotes from this article:

“The etiology and pathogenesis of these disorders are poorly understood, and diagnostic criteria have been historically controversial.”

“Overall, no good medical therapy exists.”

“After a cholecystectomy, “37% were classified as having an unsatisfactory result, 25% reported no improvement.”

“…leading the authors to conclude that data supporting the use of gallbladder ejection fraction in the evaluation of patients with abdominal pain suggestive of the biliary disease are insufficient, with the caveat that the quality of the data was low.” [7]

In 2009, A Cochrane review article was published, and it discussed the efficacy of a cholecystectomy, “…evidence is not sufficient to recommend cholecystectomy for patients with gallbladder dysfunction and that further randomized clinical trials are needed.” [8]

Neither surgery nor symptomatic therapy focuses on the root of the problems causing biliary dyskinesia. They mask the symptoms, thus making the condition chronic. Primum non nocere is a Latin phrase that means “first, not harm.” It is a fundamental principle of medicine throughout the world.

Taking into consideration this fundamental principle of medicine, removing a human organ should not be taken lightly. If everything in the human body that is not working optimally gets cut out, we would not have much left in our bodies! Removing the gallbladder without having structural damage or inflammation is very questionable. Issues with bile ducts and the sphincter of Oddi may not only persist but worsen after gallbladder removal surgery.

Taking into account scientific research, clinical evidence, and common sense, treating biliary dyskinesia should start with a non-invasive approach. Some methods of complementary or alternative medicine can be particularly useful with biliary dyskinesia. The Western medical world has its strengths and weaknesses, as we all do. Since it does not focus on alternative medicinal ways to treat biliary dyskinesia, let’s discuss non-surgical treatments. This is information that you may not have received and can greatly impact your life.

  1. We need to make bile more liquid and less congested. Drinking plenty of water, fresh vegetable blends or juices, eating vegetable soups, drinking Karlovy Vary healing mineral water, and having a nice pot of herbal tea may help keep bile fluid. Avoiding dehydration is mandatory.
  2. Encourage the liver to produce more bile. Some herbs such as barberry, rose hips, fennel, corn silk, and peppermint have choleretic actions that lead to producing more bile. Clinical studies of European doctors proved that drinking Karlovy Vary healing mineral water can help the liver produce more bile. [10, 11]
  3. We need to reduce congestion in the gallbladder by opening the bile ducts and sphincter of Oddi. Many people don’t know that acupuncture and electro-acupuncture decrease spasms and pains caused by biliary dyskinesia. [12, 13, 14]
  4. Mother Nature positioned most of the digestive organs in the abdomen. And each of our organs needs its space to work. The gallbladder is in a tight spot (literally) since it is squeezed between the liver, stomach, duodenum, and large intestine. There is not a lot of room in this area. If a person suffers from belly fat, gas, or constipation, the pressure inside the abdomen increases, just like when we wear tight clothes or belts. This, in its turn, causes more restrictions on the gallbladder. Gentle abdominal massage, point massage, or chiropractic manipulations may decrease adhesions. These remedies allow the gallbladder to move freely, have better motility, and fewer spasms occur.
  5. Many Americans have congested gallbladders because they are afraid to eat fatty food products. Because of wrong propaganda, people stay away from eggs, avocados, sour cream, butter, oily fish, coconut oil, and cold-pressed olive oil. These foods are natural stimulants of the bile ejection. Opposing, animal fats, trans fats, the combination of fats and sugars, alcohol, unhealthy eating habits such as eating on the go, irregular meals, overeating, “crash” dieting, soda-instead-of-water-drinking leads to gallbladder congestion, gallstone producing and, in a case of biliary dyskinesia, needs to be avoided. You may need to rethink what you consider to be “good” and “bad” food.
  6. This next point is virtually unknown, even in the healthcare industry. Bile’s acidity and toxicity are the primary factors for biliary dyskinesia. A natural, alkaline diet, various cleansing techniques, herbs, alkaline minerals, the restoration of friendly intestinal flora, fighting with parasites, and Candida-yeast overgrowth can decrease symptoms of this condition.
  7. With biliary dyskinesia, European doctors recommend drinking Karlovy Vary healing mineral water either from the thermal spring directly or at home. This water is not simply mineral water that people drink when they are thirsty. Karlovy Vary healing mineral water has been used as a medicinal remedy for 500 years. Dissolving genuine Karlovy Vary thermal spring salt into the water makes it possible to drink this healing mineral water at home. Minerals, bicarbonate, and trace elements neutralize the acidic compounds in the bile, and water helps to eliminate them from the body. According to medical literature, thousands of people with biliary dyskinesia improve the motility of the gallbladder and sphincter of Oddi by using this healing mineral water. Taking some mineral supplements such as cellular magnesium-potassium also neutralizes acidity, decreases spasms, and abdominal pain.
  8. Females either in puberty or perimenopausal age, suffer more from biliary dyskinesia. It may be attributed to the women’s hormone levels. Other factors that make symptoms of biliary dyskinesia worse are anxiety and stress. Acupuncture, herbs, self-hypnosis by listening to customized CDs at home can also help.

Mother Nature does not make mistakes. The gallbladder is a critical member of the digestive team. When there are no stones or severe inflammation in the gallbladder, especially in children and young adults, or otherwise healthy people, the removal of the gallbladder may be unnecessary. It makes sense to improve its sluggish function and decrease congestion in the bile ducts.

Medical statistics show that gallbladder removal surgery does not guarantee a pain-free life. For some, life without a gallbladder is chronically unhappy and painful. A search for “postcholecystectomy syndrome,” “pain, diarrhea, bile reflux, pancreatitis after gallbladder removal” on the Internet may perfectly illustrate people’s unfortunate experiences with a cholecystectomy.

Interesting Facts at a Glance:

  • Biliary dyskinesia is a functional disorder that can manifest by attacks of colicky abdominal pain at the right upper quadrant (RUQ) 
  • Pain may radiate to the upper back or right shoulder blade, and the person can be nauseated.
  • In the case of biliary dyskinesia, the blood and imaging test results may come back normal.
  • A particular visual test-cholescintigraphy (HIDA scan) may show low gallbladder ejection that indicates abnormal gallbladder motility.
  • HIDA scan remains highly debated due to the false-positive rates are given to healthy individuals.
  • There are no long-time researches, which show benefits of a gallbladder removal in children, teens, young adults, and otherwise healthy persons with the low function of the gallbladder. By opinions of many doctors, cholecystectomy in case of biliary dyskinesia remains very controversial subject.0
  • Gallbladder removal surgery is not the best solution for biliary dyskinesia. Almost 20-40 percent of patients after a cholecystectomy continue to suffer from pain and indigestion (postcholecystectomy syndrome). 
  • In functional biliary disorders without serious inflammation, gallstones, or structural problems, the focus needs to be on repairing gallbladder motility. 
  • Non-drug and non-knife alternative medicine approaches are extremely suitable for individuals with biliary dyskinesia.
  • Healing, alkaline diet, normalizing acid-alkaline balance, weight issue, physical activity, and hydration is necessary for biliary dyskinesia. 

Have a Question?? Ask us here

References:

Ziessman HA. Cholecystokinin cholescintigraphy: victim of its own success? J Nucl Med. 1999 Dec;40(12):2038-42[1].

Mark Tulchinsky, MD, FACNM. Applied hepatobiliary scintigraphy in chronic gallbladder diseases. Applied Radiology. Sep 5, 2016.http://appliedradiology.com/articles/applied-hepatobiliary-scintigraphy-in-chronic-gallbladder-diseases[2]

Zakko SfF, Zakko WF, Chopra S. Functional gallbladder disorder in adults. UpToDate. May 11, 2016. http://www.uptodate.com/contents/functional-gallbladder-disorder-in-adults[3]

Tierney S, Nakeeb A, Wong O, et al. Progesterone alters biliary flow dynamics. Ann Surg. 1999; 229(2):205-209.[4]

http://www.ddc.musc.edu/public/diseases/small-intestine/dysmotility.html[5]

http://www.reflux.org/reflux/webdoc01.nsf/(vwWebPage)/Dysmotility.htm?OpenDocument[6]

Goussous N, Kowdley G.C, Sardana N, Spiegler, Cunningham S.C. Gallbladder Dysfunction: How Much Longer Will It Be Controversial? Digestion 2014;90:147-154 [7]

Gurusamy KS, Junnarkar S, Farouk M, Davidson BR: Cholecystectomy for suspected gallbladder dyskinesia. Cochrane Database Syst Rev 2009;CD007086.[8]

Penning C, Gielkens HA, Delemarre JB, Lamers CB, Masclee AA: Gall bladder emptying in severe idiopathic constipation. Gut 1999;45:264-.[9 Benda, J. Karlovarsky Mlynsky Pramen. Domaci pitna lecba.  DTP-servis mariuuskelazue. (1997). On Czech [10]

Solc, P. Karlovarska lazenska leba a medicina na prelomu  20. A21. Stoleti.  (2000). Galen, Praha. On Czech[11]

]Myung-Hwan Kim. The Journal of Alternative and Complementary Medicine.Dec 2001.ahead of printhttp://doi.org/10.1089/107555301753393887 [12]

https://www.ncbi.nlm.nih.gov/pubmed/24008012 [13]

https://www.acupuncture.org.uk/public-content/public-ask-an-expert/ask-an-expert-body/ask-an-expert-body-abdomen-gastro-intestinal/4784-can-acupuncture-help-with-sphincter-of-oddi-dysfunction.html [14]

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