Functional gallbladder disorder

Previously called biliary dyskinesia

Pathophysiology

• GB dysmotility - creates pain in the absence of gallstones
• Has been associated with abnormal colonic transit and gastric emptying

Presentation

• Classic biliary colic, but with no gallstones or sludge

Diagnosis

• Diagnosis of exclusion
  • USS
  • Repeat USS with special attention to GB infundibulum and Hartmann's pouch and phrygian cap
  • Gastroscopy
  • ?Bile microscopy for microcystal disease
  • Consider Sphincter of Oddi dysfunction
• CCK-stimulated HIDA to evaluate GB ejection fraction
  • <35-40% at 20 minutes after CCK administration in a patient without stones is considered diagnostic
  • See separate topic under 'biliary imaging'
• Use Rome IV criteria for functional GB disease

Management

• Note that surgery for this is very common in USA, but much less common in Australia
• May resolve spontaneously - reportedly up to 50%, but this is probably an overestimate
• Indications for surgery (as per UTD)
  • Functional GB disorder criteria causing severe symptoms over a period of three months
  • Typical biliary pain
  • GB EF <40%
• Cholecystectomy is effective in >85% of patients meeting indications
  • Less helpful in patients with bloating, fullness, dyspepsia - generally do not operate
• ERCP with sphincterotomy may prove useful