Do you sometimes feel a sharp pain in the upper right side of your stomach after eating, especially a fatty meal? Do you feel nauseous or feel like vomiting? Many people think that this is due to gallstones. But that is not always the case. Today we are going to talk about another gallbladder problem that causes similar symptoms, but is not caused by stones. That is a condition called Biliary Dyskinesia .
What is Biliary Dyskinesia? Let's understand it simply!
Okay, first let's look at what Biliary Dyskinesia is. Simply put, it's a problem with the way your gallbladder works. Sometimes, it can also affect the function of the sphincter, a small muscle that controls the flow of bile into the intestines. What happens here is that the gallbladder doesn't work properly. That is, it's not like there's a gallstone stuck in the gallbladder, but rather a problem with the way the gallbladder works.
Did you know that the main function of our gallbladder is to store bile, which is made by the liver, and then send it to the small intestine to help digest food when we eat. When we eat, hormones from the small intestine send a signal to the gallbladder, saying, "Okay, send the bile now." Then the gallbladder contracts, meaning it shrinks, and sends the bile through the bile ducts to the small intestine.
In biliary dyskinesia, there is a problem somewhere in this process. It could be a problem with the hormone signal, or it could be a problem with the nerves that receive the signal, or it could be a weakness in the muscles that are supposed to act on the signal. Doctors can't immediately say exactly what causes this, but they understand that the gallbladder isn't releasing enough bile.
What happens to the body due to Biliary Dyskinesia?
Now, what happens when the gallbladder can't properly empty its bile? That bile builds up inside the gallbladder, causing it to become distended and swollen. This is similar to what happens when a gallstone gets stuck in the gallbladder. This swelling and accumulation of bile can lead to infections, inflammation of the gallbladder (cholecystitis), and pain.
You may occasionally experience pain in the upper right side of your abdomen. It comes and goes. This pain is often accompanied by nausea, especially when the gallbladder contracts after eating. This is called biliary colic . In addition, the intestines may not get enough bile, which can cause bloating, nausea, vomiting, and difficulty digesting food, especially when eating fatty foods.
It has long been believed that biliary pain is almost always caused by gallstones (cholelithiasis). But doctors are now realizing that this is not always the case. In fact, a condition called biliary dyskinesia is now being recognized as a major cause of gallbladder disease. It affects both older children and adults .
Who is more likely to develop Biliary Dyskinesia?
Functional gallbladder disorders have been a hot topic of discussion recently, especially in countries like the United States. It is not yet clear whether the condition is actually increasing or whether it is just now being recognized. It is also not clear who is more likely to develop it. However, it is thought that people with obesity and diabetes may be at increased risk.
As you know, obesity has various effects on our body's metabolism. It can cause fat to accumulate in our organs, and it can also cause chronic inflammation. Both of these things affect gallbladder motility. When bile in the gallbladder sits in one place, it can become thick and sludgy. This is what causes gallstones. Obesity is a major risk factor for gallstones. However, gallstones can also develop after a condition called Biliary Dyskinesia.
How does this gallbladder dysfunction feel?
Most people feel gallbladder pain right where the gallbladder is located - in the upper right side of the abdomen, just below the right rib cage. But some people feel it in the middle of the abdomen, and others in the right shoulder or back. It comes on intermittently and is not constant. But when it does come, it can last for hours. The pain gradually increases over the first 20 minutes, then gradually decreases.
These pains come and go, not all the time. They usually occur after eating, especially after eating a heavy, fatty meal. This is when the gallbladder contracts and needs to release bile into the intestines. The pain is usually severe, enough to interrupt your daily activities, wake you up at night, or even require a trip to the emergency room. Nausea and vomiting are also common.
What are the symptoms of Biliary Dyskinesia?
A person with Biliary Dyskinesia may typically experience these symptoms:
- Pain in the upper right part of the stomach.
- Pain that occurs from time to time, peaks and then subsides.
- Filling the stomach, bloating.
- Nausea and vomiting.
- Unintentional weight loss.
Some people also report other symptoms:
- Headache.
- Chronic fatigue, exhaustion.
- Chronic acid reflux.
- Functional indigestion and/or (IBS - Irritable Bowel Syndrome).
- Anxiety and/or Depression.
What are the causes of Biliary Dyskinesia?
In fact, doctors still don't know exactly what causes these motility disorders. Sometimes, specific nerves, such as the vagus nerve, may be involved. But in many cases, it's hard to pinpoint exactly where the problem lies. Sometimes, a general metabolic disorder or intestinal motility disorder can affect the movement of the gallbladder or bile duct's closing muscle, the biliary sphincter.
How is Biliary Dyskinesia diagnosed?
Biliary dyskinesia is diagnosed in several steps. Doctors need to confirm the following:
1. Are your symptoms indicative of biliary pain or other abdominal pain?
2. You do not have any other specific gallbladder disease, such as gallstones.
3. Your gallbladder is not producing enough bile.
4. Your symptoms occur when the gallbladder contracts.
5. The medications you take or other factors do not affect the movement of the gallbladder.
Symptom check
First, the doctor will ask you about your symptoms and see if you have any specific symptoms related to biliary colic. They will consider these criteria:
- The pain occurs in the upper abdomen, usually on the right side.
- The pain recurs occasionally and lasts for at least 30 minutes.
- The pain gradually increases, reaches a moderate or severe level, and then stabilizes.
- Pain that is not relieved by vomiting, defecating, changing position, or taking antacids.
- These pain conditions have been occurring regularly for at least three months.
Exclusion of other medical conditions
After confirming that your symptoms fit these criteria, your doctor will try to rule out other common causes of gallbladder pain. This may include:
- Blood tests: Pancreatic enzyme and liver enzyme levels are checked. If the enzyme levels are high, it could be a sign of a problem with these organs or a bile buildup (especially high bilirubin).
- Abdominal ultrasound: This examines the gallbladder and bile ducts. It looks for structural causes such as gallstones, thickening of the gallbladder wall, or dilation of the bile ducts.
Checking gallbladder function
If your blood tests and ultrasound scan are normal, the next step is to check your gallbladder function. Doctors do this with a special nuclear medicine imaging test called a HIDA scan . In this test, a technician injects a radioactive isotope (a tracer) into your vein. As the tracer travels through your gallbladder, a computer scanner reads it and creates images on a screen.
To check gallbladder function, doctors add another step to this test. It's called a cholecystokinin check . Cholecystokinin is a hormone that tells the gallbladder to contract and release bile into the bile ducts. The technician injects cholecystokinin into your vein and takes another series of images as the gallbladder contracts. They monitor it and take measurements.
Your doctor will ask you if you feel the pain in your gallbladder that you mentioned earlier when your gallbladder contracts. They will also measure your gallbladder's "ejection fraction." This is how much bile is released when your gallbladder contracts. If your ejection fraction is less than 40%, and you are not taking other medications or hormone treatments that are slowing down your gallbladder's movement, they will diagnose you with biliary dyskinesia.
Think of it like a "fitness test" for the gallbladder. It measures how efficiently the gallbladder is doing its job.
Very rarely, a doctor may perform a very specific test that measures how well the sphincter of Oddi, the muscle at the junction between the bile duct and the intestine, opens in response to signals from the body. This test can only be done in specialized centers. The doctor will anesthetize you and insert a special endoscope through your mouth, similar to an upper endoscopy or EGD. Then, the endoscope is passed down to the first part of your small intestine and measures the relaxation of your sphincter of Oddi.
Often, doctors can diagnose sphincter of Oddi dysfunction only after ruling out all other causes of biliary motility disorders. Sometimes, this diagnosis is made when a patient's symptoms do not improve even after the gallbladder is removed.
(Biliary Dyskinesia) Will it get better on its own?
There is no evidence that biliary dyskinesia will improve on its own. Typically, biliary dyskinesia is diagnosed after you have had symptoms for at least three months. At that point, no one wants to just wait for it to get better. If it does improve on its own, it may not actually be a functional disorder, but a different type of movement disorder caused by temporary factors.
How is Biliary Dyskinesia treated?
The only successful treatment for biliary dyskinesia is cholecystectomy . This is usually done as a minimally invasive procedure (laparoscopic surgery). This means that the surgery is done through a few small incisions. You can go home the same day. Laparoscopic surgery heals faster, leaves less scarring, and is less painful. You can live well without a gallbladder. Your liver then pumps bile directly into the small intestine.
However, if the doctor determines that the sphincter muscle is the cause of the movement disorder, the muscle can be widened or opened using an endoscopic procedure. This is usually done if symptoms persist after the gallbladder has been removed. In fact, it is difficult to diagnose sphincter dysfunction, and it is very rare for the movement disorder to be limited to that muscle. Often, the gallbladder is also affected.
What can happen after a gallbladder removal surgery (cholecystectomy)?
It will take a few weeks for your digestive system to adjust to the absence of your gallbladder. During this time, you may have difficulty digesting fats. Many doctors recommend temporarily changing your diet to avoid indigestion. Avoid fried and fatty foods at first. Also, focus on foods high in fiber. Gradually add whole grains, vegetables, and legumes back into your diet. This will help prevent bloating and gas.
How is the condition after treatment for Biliary Dyskinesia?
For those who meet all the criteria for diagnosis, cholecystectomy is 90% effective in treating biliary dyskinesia. However, not everyone meets all of these criteria. Such people should undergo further testing before undergoing surgery, as they may have another underlying condition. If the diagnosis is not certain, removing the gallbladder will not necessarily improve symptoms.
Gallbladder pain has specific symptoms. If you can identify the condition (Biliary Colic), you and your doctor may first suspect gallstones. That's not wrong. But what if gallstones are not found to be causing your symptoms? Then you may have a functional gallbladder disorder (Biliary Dyskinesia). Diagnosing Biliary Dyskinesia is a process. But if the diagnosis is correct, treatment is more likely to be successful.
Remember the most important thing (Take-Home Message)
If you also experience persistent pain in the upper right side of your abdomen after eating, especially after eating fatty foods, along with symptoms like nausea and vomiting, don't just dismiss it as gastritis. It could be gallstones, or it could be a condition like the one we talked about today (Biliary Dyskinesia).
Remember, not all stomach aches are the same. Pay close attention to your symptoms. It's important to see a doctor to find the exact cause. With the right diagnosis and proper treatment, you can get rid of this discomfort. Don't panic, follow your doctor's advice.
Limiting your intake of oily and fatty foods and maintaining a healthy weight can go some way to protecting yourself from these conditions. Above all, listen to your body.
` Gallbladder, Biliary Dyskinesia, Bile, Abdominal pain, Cholecystectomy, HIDA scan, Digestion
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