biliary dyskinesia

[coba37]

I have biliary dyskinesia with an ejection fraction of 23%. I am on a very low fat diet and I eat very little dairy or wheat.I have become very skinny since this began-- about 2 years ago. My symptoms include stomach pain that moves all over my stomach area after almost every meal, but especially dinner, nausea, bloating, gas, intestinal pain, sore throat, sometimes a feeling of heaviness/pain at my sternum, but I do not have upper right quadrant pain. Isn't that the most common gallbladder problem symptom? The doctors suggest surgery, but I don't understand why it would be helpful to remove an at least partly functioning gallbladder? I understand why removing the gallbladder might help relieve pain in the gallbladder area if the gallbladder is irritated, but how will removal help with my symptoms? And, why will removing the gallbladder help reduce the the overabundance of acid in my stomach? Nobody has been able to answer these questions for me, and thus, I've refused surgery and have been getting acupuncture instead for the past 6 months. I'm flirting with the idea of surgery again because I'm not sure that acupuncture is going to be able to heal the problem. It hasn't so far, but it has helped to relieve some symtoms. I would be very grateful if you can help answer my questions, and I am open to any suggestions you have to offer.

Sincerly, amy

[Christopher R Watters, MD]

If your ejection fraction were 25-30% I would have my doubts but one of 14% is profoundly abnormal. With a thoughtful workup being otherwise negative I would strongly consider cholecystectomy.

[consty]

I have ejection fraction of 14% with no gallstones.  Symptoms are Bloating, mid gastric pain to the back.  The main symptom that landed me in the ED one year ago was severe left upper abdominal pain from back to front.  CT normal.  No diagnosis.  3 weeks later I had diagnosis of EBV.  After splenomegaly reduced, left pain reoccurred with abdominal distention and pain after fatty meals.  I have been on low fat, gluten free diet for 2-3 months and lost 15 pounds.  Pain mainly on left and abdominal bloating occur with almost any foods now. Surgeon is not sure cholecystectomy will cure symptoms.  Colonoscopy, EGD with internal ultrasound were all negative.  What do you think?

[consty]

I have ejection fraction of 14% with no gallstones.  Symptoms are Bloating, mid gastric pain to the back.  The main symptom that landed me in the ED one year ago was severe left upper abdominal pain from back to front.  CT normal.  No diagnosis.  3 weeks later I had diagnosis of EBV.  After splenomegaly reduced, left pain reoccurred with abdominal distention and pain after fatty meals.  I have been on low fat, gluten free diet for 2-3 months and lost 15 pounds.  Pain mainly on left and abdominal bloating occur with almost any foods now. Surgeon is not sure cholecystectomy will cure symptoms.  Colonoscopy, EGD with internal ultrasound were all negative.  What do you think?

[briz3501]

Thank you for taking the time to read my post and respond.  It's greatly appreciated.  The idea of an every-other-year ultrasound to check for stones is such a prudent one and something that has not been mentioned to me before, so kudos to you. :-)   I will discuss that with the gastroenterologist next week.  Again, thank you for your time.

[Christopher R Watters, MD]

The chances of an acute complication in the scenario of non stone gallbladder disease is low. Whereas symptomatic patients with gallbladder disease and gallstones should undergo cholecystectomy due to their increased risk of early death without surgery the data doesn't support this for dyskinesia. It is my belief that the majority of these patients eventually go on to form gallstones though. If this is the case, they will then meet criteria to recommend cholecystectomy. In your situation, I would let you make the call. In the mean time, repeating an ultrasound every other year or so would be prudent. If you do develop gallstones, time to stop delaying.

[briz3501]

Dr. Watters, I'm 46 yr old female, 5'2", 118 lbs.  I've had gallbladder pain off/on for 6 years.  I know my triggers (coffee and if I've been eating a lot of high fat foods/deserts for a good stretch of time - say over the course of 2-3 weeks - this will bring on an episode).  

When I have the episodes, I feel a very distinct pain/pressure under the right rib cage with significant rebound when I push in.  The pain is not bad enough to go to the ER.  I know, from the years of experiencing this, exactly what I'm feeling. I've had ultrasounds done when I'm in the throes of an 'attack' and it shows the gallbladder distended but no stones.  

I've then had ultrasounds done when everything is 'quiet' and the gallbladder appears perfectly normal (no distention).  In the past 2 months I've had an URQ abdominal ultrasound - normal, a gastroscopy - normal , all blood tests including liver function/pancreas - normal.  Finally I had a HIDA scan - EF of 26%.   (I also had a colonoscopy 4 yrs ago - normal)

The EF of 26% is no surprise to me.  The pain I get is classic URQ gallbladder pain that wraps around to the back, is tender upon palpation and feels almost like there's a 'hot balloon' stuck up under my right ribs.  The last few episodes I've had (past year) however sometimes the pain seem to move from the right to the center (epigastric) when it's occuring.

Here's my quandary:  I only get these 'attacks' perhaps 3-4 times a year.  When they happen the first day is the most acute, the discomfort gradually lessens and the pain is completely gone by day 3.   During this time I DO eat, just lightly and in small amounts. Interestingly, I tend to be constipated right before the attacks happen.  I have never had nausea with this, just decreased appetite, some acid reflux and the URQ pain.  The pain has never awakened me at night and, interestingly, seems to abate by the time I go to bed.

My primary doctor is strongly urging me to get a cholecystectomy.  His fear is if I have crystals or very tiny stones that one will lodge in a bile duct and will result in a surgical emergency which, as you say, carries much greater risks.  I am reluctant because I don't want to trade one set of problems for another (diarrhea or digestion issues without the gallbladder).  I've had stomach issues my ENTIRE life since childhood.  

My question to you is this: if I do NOT have a cholecystectomy, am I risking permanent damage to my gallbladder (scarring, calcification or worse) by just living with a sluggish gall bladder and occasionally have these attacks?   I feel I can manage my symptoms if I am diligent with my diet.  I've gone as long as 6 mos without an episode when I've been most diligent with my diet.

I have a consult with a gastroenterologist to discuss this but am curious, from your perspective as a surgeon, what your suggestion might be.  Interestingly I have only talked with my primary about this but am not going to make a decision for surgery until I've consulted with a gastroenterologist.  

Thank you very much for your time and thoughts.