Biliary dyskinesia pathophysiology
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Shakiba Hassanzadeh, MD[2]
Overview
The exact pathophysiology of biliary dyskinesia is unknown. However, there have been some suggestions as the causes of biliary dyskinesia such as the following: the biliary pain in gallbladder dyskinesia may be the result of gallbladder inflammation due ineffective gallbladder contraction caused by gallbladder dysmotility, visceral hypersensitivity, and receptor or neurologic abnormalities. Consequently, abnormality in gallbladder or sphincter of Oddi contraction results in inflammation and biliary pain.
Pathophysiology
- Biliary dyskinesia is characterized by low gallbladder ejection fraction during cholecystokinin-stimulated cholescintigraphy (CCK-CS).5
- The exact pathophysiology of biliary dyskinesia is unknown.[1]
- However, the following suggestions have been proposed as the causes of biliary dyskinesia:[2]
- The biliary pain in gallbladder dyskinesia may be the result of gallbladder inflammation due ineffective gallbladder contraction caused by gallbladder dysmotility following a change in bile composition.[3][4][5]
- May be the result of visceral hypersensitivity (hypersensitivity of the neural pathways communicating with the intestines) seen in patients with sphincter of Oddi dysfunction or irritable bowel syndrome.[3][6]
- May be the result of receptor/neurologic abnormalities (such as problems in cholecystokinin (CCK) release, decreased sensitivity or density of CCK receptor in the gallbladder, or increased sensitivity of CCK receptor in the cystic duct with impaired contractility of the smooth muscle.[7]
- Consequently, abnormality in gallbladder or sphincter of Oddi contraction results in inflammation and biliary pain.[1]
References
- ↑ 1.0 1.1 Clark CJ (2019). "An Update on Biliary Dyskinesia". Surg Clin North Am. 99 (2): 203–214. doi:10.1016/j.suc.2018.11.004. PMID 30846030.
- ↑ Francis G, Baillie J (2011). "Gallbladder dyskinesia: fact or fiction?". Curr Gastroenterol Rep. 13 (2): 188–92. doi:10.1007/s11894-010-0172-6. PMID 21222059.
- ↑ 3.0 3.1 Desautels SG, Slivka A, Hutson WR, Chun A, Mitrani C, DiLorenzo C; et al. (1999). "Postcholecystectomy pain syndrome: pathophysiology of abdominal pain in sphincter of Oddi type III". Gastroenterology. 116 (4): 900–5. doi:10.1016/s0016-5085(99)70073-9. PMID 10092312.
- ↑ Velanovich V (1997). "Biliary dyskinesia and biliary crystals: a prospective study". Am Surg. 63 (1): 69–74. PMID 8985075.
- ↑ Yap L, Wycherley AG, Morphett AD, Toouli J (1991). "Acalculous biliary pain: cholecystectomy alleviates symptoms in patients with abnormal cholescintigraphy". Gastroenterology. 101 (3): 786–93. doi:10.1016/0016-5085(91)90540-2. PMID 1860640.
- ↑ Wald A (2005). "Functional biliary-type pain: update and controversies". J Clin Gastroenterol. 39 (5 Suppl 3): S217–22. doi:10.1097/01.mcg.0000156112.76856.26. PMID 15798488.
- ↑ Ziessman HA (2006). "Functional hepatobiliary disease: chronic acalculous gallbladder and chronic acalculous biliary disease". Semin Nucl Med. 36 (2): 119–32. doi:10.1053/j.semnuclmed.2005.12.001. PMID 16517234.