Gallbladder symptoms develop when there is a problem with getting bile into the intestine after a fatty meal. Patients can experience bloating, belching, fullness, nausea, and vomiting related to having undigested fats in the intestine. These fats are broken down by bacteria in the gut and foul smelling gas is created. Undigested fats may also cause disruptions in normal bowel movements which can result in loose bowel movements after fatty meals.
While the most common cause of gallbladder symptoms involves the development of gallstones, many patients present with gallbladder symptoms and no stones are seen on imaging tests. Though gallbladder symptoms related to gallstones are far more common, the gallbladder can also malfunction without stones. Sometimes the gallbladder doesn’t respond correctly to the signal to squeeze. It can respond by ineffectively squeezing or by squeezing too aggressively. This is called biliary dyskinesia.
Biliary dyskinesia can cause the same pain as is experienced by people who have gallstones and result in improper digestion of fats which can lead to bloating, belching, fullness, nausea, vomiting, foul smelling gas, and irregular bowel movements.
Biliary dyskinesia can be diagnosed in patients without gallstones who undergo a HIDA (hepatobiliary iminodiacetic acid) scan. This scan involves the use of an IV injection of a chemical that will be visible on certain scans. The body treats this chemical like bile and stores it in the gallbladder right away. Once the gallbladder is full, we give a chemical called CCK – the same substance that your body naturally sends when you eat a heavy meal to signal the gallbladder to squeeze. We then measure how much of this chemical the gallbladder squeezes out. A normally functioning gallbladder would squeeze 35-50% out when signaled. A gallbladder that squeezes less or more than this is amount is functioning abnormally. Additionally, patients often describe that they feel the same symptoms they complain of when they receive that CCK as it is mimicking the reaction to a heavy meal.
Biliary dyskinesia can be treated similarly to other gallbladder problems with laparoscopic cholecystectomy or gallbladder removal.