Hida Scan Results - 98% Fraction Injection Rate

[cheyane926]

For the last year I have been having problems with my stomach with pain, fatigue, nausea and more.  I had an ultra sound done last week and it was normal.  My primary care doctor sent me for a Hida Scan and the results were a 98% Fraction Injection Rate.  She now has be going to see a surgeon to have my gallbladder removed because is is over active.  Is this a proper procedure and what does the 98% actually mean.

[Kelsoxoxo]

Like the doctor said, with everything else being ruled out after all your many tests you have had done, and the fact that you do indeed have Hyperkinetic Biliary Dyskinesia, as proven by your HIDA testing with your extremely high ejection rate, your symptoms would probably be resolved by having your gallbladder removed. Studies show that almost every patient who had the same problem and had surgery, usually has complete resolution long term. When the gallbladder is hyperactive, it causes multiple issues. 1: the bile being ejected to quickly and too forcefully stretches, distends, irritates, inflames and causes pain to the biliary ducts. 2: a hyperactive gallbladder has been shown to produce bile at inappropriate times, esentially being "trigger happy" and dumping bile into empty intestines, which causes much inflammation and resulting pain and system stress. 3: a hyperactive gallbladder, upon surgical removal usually always shows as being diseased, having scar tissue, inflamed, enlarged, or other problems upon examination and lab study.

[Noreenmarymooney]

First, If you drink alcohol stop, if you take prescriptions for mental health stop; your gallbladder will clear up, don't remove it, eliminate the cause, not the organ, you were born with a gallbladder because your body needs it, removing it will be a darker fate. Doctors get too trigger happy, they do things too hastily. Take care.

[SPRINGTIMEYELLOW]

A couple more things, I had two colonscopies and one endoscopy every thing was normal

[SPRINGTIMEYELLOW]

I'm seriously confused The computer generated report I was sent   IVC Aorta unremarkable, My speen is grossly unremarkable. No Hydronephrosis on either side. Unremarkable abdominal ultrasound,  Pancreas is grossly normal unremarkable hepatic echotexture is normal,  no gallstones, or pericholecystic fluid or wall thickening.  Gallbladder  Ejection Fraction rate was 98% the report said that was normal..I thought  the  high score  reflected the functioning level of the Gall Bladder is this wrong ? Do I have Gastritis?

[Christopher R Watters, MD]

The fact that you have objective findings in the duodenum, stomach, and esopagus is significant. These, combined with the extremely high gallbladder ejection fraction would be suggestive of bile reflux gastritis. This is when bile that enters the duodenum (the piece of small intestine that the stomach empties into), rather than passing downstream, some also refluxes backwards across the pylorus into the stomach. The stomach is generally very good at handling acid but is not good at handling alkaline fluids like bile. The bile in the stomach then refluxes into the esophagus causing inflammation. There is mounting evidence that the bile salts in the bile may be responsible for a condition known as Barrett's esophagus which can result in cancer in 10% of afflicted patients. I have become convinced that patients with hyperactive gallbladders on HIDA may actually be having "trigger happy" gallbladders that empty inappropriately into an empty GI tract rather than on demand when there is food present. A sudden bolus of bile into the duodenum results in a least a portion of it refluxing into the stomach.

With the findings that you describe I would tend to favor a trial of sucralfate for a month or so. This coats the stomach and protects it from either alkaline or acid damage and lets it heal. If this doesn't help then I generally recommend cholecystectomy.

[cheyane926]

Dr. Watters..I had my endoscopy yesterday and these are the results...does any of this have to do with the gallbladder...
Grade a... Esophagitis compatible with erosive esophagitis. 2. Granularity and erythema in e Antrum compatible with gastritis. 3.  Granularity and erythema in the duodenal bulb and second part of the duodenum compatible with duodenitis. 4.  Erosion in the duodenal buld.  Recoomendations were to follow up with gastroenterogist in one month, no alcohol, resume regular diet, no aspirin.  Does not seem like any sort of fix for me...I can't take this pain anymore...I have a call into the gallbladder surgeon to see what he thinks.  Thanks for your advise.

[Christopher R Watters, MD]

That sounds very supportive of your gallbladder as the source. I do feel yhat the endoscopy is indicated because this is still an unusual indication for cholecystectomy and I feel it is important to rule out other potential sources before operating on these patients. One other thing I typically do is to give them a trialmof Carafate and Reglan. I think some of these patients basically have a trigger happy gallbladder that fires off inappropriately and results in a bolus of bile being delivered into an empty duodenum. This then refluxes backwards into the stomach causing pain from the gastritis and also spasm of the pylorus. I find that a respectable portion of these patients can be taken care of without surgery with these strategies.

[cheyane926]

Dr. Watters,  Thank you for getting back with me.  This information is extemely useful. During the CCK I did experience the same nausea and pain that I have been having for almost a year.  So I guess my symptoms were reproduced and since having the CCK last Friday (27 Jul 12) I have felt extemely worse.  I will speak to my Primary Care regarding the upper endoscopy.  Also, my stools at times are very whitish in color and she stated that is also a sign of my gallgladder.  Thank you for your time.  

[Christopher R Watters, MD]

The number alone is not meaningful. In reviewing numerous studies looking at HIDA scans in normal volunteers ejection fractions in the 90's are not unusual. If your symptoms were reproduced with the CCK and the ejection fraction were extremely high then it would be considering. An upper endoscopy should be done first to rule out other causes. Your PCP sounds like an authority...... After dealing with similar patients over the past 20 years there have finally been a handful of articles published looking at this group. The problem is that most of these HIDA scans are read as normal since the ejection fraction is over 35%. in my experience, when other causes formthe pain have been ruled out, over 90% of patientsnwith ejection fractions over 85% and symptom reproduction with CCK have had their problems reaolve or improve significantly with cholecystectomy.