Current Gastroenterology Reports

, Volume 8, Issue 2, pp 172–176

Biliary dyskinesia in pediatrics

Article

Abstract

Biliary dyskinesia is a potential cause for acalculous biliary colic in pediatric patients. A triad of symptoms and signs, consisting of abdominal pain (with or without associated nausea or fatty food intolerance), absence of gallstones, and an abnormally low cholecystokinin-stimulated gallbladder ejection fraction is used to diagnose the disorder. In several small pediatric case series, cholecystectomy resulted in symptomatic improvement in a majority of patients with biliary dyskinesia. However, the diagnosis of biliary dyskinesia and appropriate management remain controversial. This review discusses the purported pathophysiology of biliary dyskinesia and the data available regarding diagnosis and treatment of this entity in the pediatric population.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References and Recommended Reading

  1. 1.
    Campbell BT, Narasimhan NP, Golladay ES, Hirschl RB: Biliary dyskinesia: a potentially unrecognized cause of abdominal pain in children. Pediatr Surg Int 2004, 20:579–581. Most recent descriptive case series on effects of cholecystectomy in children with biliary dyskinesia.PubMedCrossRefGoogle Scholar
  2. 2.
    Al-Homaidhi HS, Sukerek H, Klein M, Tolia V: Biliary dyskinesia in children. Pediatr Surg Int 2002, 18:357–360. Descriptive case series on effects of cholecystectomy in children with biliary dyskinesia.PubMedCrossRefGoogle Scholar
  3. 3.
    Wood J, Holland A, Shun A, Martin H: Biliary dyskinesia: Is the problem with Oddi? Pediatr Surg Int 2004, 20:83–86. Small descriptive case series on effects of cholecystectomy in children with biliary dyskinesia. Discussion on reasons for therapeutic failure of cholecystectomy.PubMedCrossRefGoogle Scholar
  4. 4.
    Gollin G, Raschbaum GR, Moorthy C, Santos L: Cholecystectomy for suspected biliary dyskinesia in children with chronic abdominal pain. J Pediatr Surg 1999, 34:854–857. Largest descriptive case series on effects of cholecystectomy in children with biliary dyskinesia.PubMedCrossRefGoogle Scholar
  5. 5.
    Dumont C, Caniano DA: Hypokinetic gallbladder disease: a cause of chronic abdominal pain in children and adolescents. J Pediatr Surg 1999, 34:858–862. Descriptive case series on effects of cholecystectomy in children with biliary dyskinesia.PubMedCrossRefGoogle Scholar
  6. 6.
    Carney DE, Kokoska ER, Grosfeld JL, et al.: Predictors of successful outcome after cholecystectomy for biliary dyskinesia. J Pediatr Surg 2004, 39:813–816.PubMedCrossRefGoogle Scholar
  7. 7.
    Hadigan C, Fishman SJ, Connolly LP, et al.: Stimulation with fatty meal (Lipomul) to assess gallbladder emptying in children with chronic acalculous cholecystitis. J Pediatr Gastroenterol Nutr 2003, 37:178–182.PubMedCrossRefGoogle Scholar
  8. 8.
    Lonovics J, Madacsy L, Szepes Z, et al.: Humoral mechanisms and clinical aspects of biliary tract motility. Scand J Gastroenterol 1998, Suppl 228:73–89. Review of physiologic regulation of the biliary motility and pathophysiologic mechanisms of biliary dyskinesia.Google Scholar
  9. 9.
    Toouli J: Biliary tract motor dysfunction. In Baillieres Clinical Gastroenterology. Edited by Dent J. London: Bailliere Tindall; 1991: 409–430.Google Scholar
  10. 10.
    Toouli J, Baker RA: Innervation of the sphincter of Oddi: physiology and considerations of pharmacological intervention in biliary dyskinesia. Pharmacol Ther 1991, 49:269–281.PubMedCrossRefGoogle Scholar
  11. 11.
    Ding X, Lu CY, Mei Y, et al.: Correlation between gene expression of CCK-A receptor and emptying dysfunction of the gallbladder in patients with gallstones and diabetes mellitus. Hepatobiliary Pancreat Dis Int 2005, 4:295–298.PubMedGoogle Scholar
  12. 12.
    Krishnamurthy S, Krishnamurthy GT: Biliary dyskinesia: role of the sphincter of Oddi, gallbladder and cholecystokinin. J Nucl Med 1997, 38:1824–1830.PubMedGoogle Scholar
  13. 13.
    Mistiaen W, Blockx P, Van Hee R, et al.: The effect of stress on gastric emptying rate measured with a radionuclide tracer. Hepatogastroenterology 2002, 49:1457–1460.PubMedGoogle Scholar
  14. 14.
    Boyle JT: Abdominal pain. In Pediatric Gastrointestinal Disease. Edited by Walker WA, Kleinman RE, Sherman PM, et al. Hamilton, ON, Canada: BC Decker; 2004: 225–243.Google Scholar
  15. 15.
    Hassall E: Decisions in diagnosing and managing chronic gastroesophageal reflux disease in children. J Pediatr 2005, 146:S3-S12.PubMedCrossRefGoogle Scholar
  16. 16.
    Hughes KH: Painful rib syndrome: a variant of myofascial pain syndrome. AAOHN J 1998, 46:115–120.PubMedGoogle Scholar
  17. 17.
    Lin EC, Kuni CC: Radionuclide imaging of hepatic and biliary disease. Semin Liver Dis 2001, 21:179–194.PubMedCrossRefGoogle Scholar
  18. 18.
    Ozden N, DiBaise JK: Gallbladder ejection fraction and symptom outcome in patients with acalculous biliarylike pain. Dig Dis Sci 2003, 48:890–897.PubMedCrossRefGoogle Scholar
  19. 19.
    Bertalan V, Madacsy L, Pavics L, Lonovics J: Scintigraphic sign of functional biliary obstruction is pathognomic for sphincter of Oddi dysfunction. Hepatogastroenterology 2004, 51:76–81.PubMedGoogle Scholar
  20. 20.
    Moseley JB, O’Malley K, Petersen NJ, et al.: A controlled trial of arthroscopic surgery for osteoarthritis of the knee. N Engl J Med 2002, 347:81–8.PubMedCrossRefGoogle Scholar
  21. 21.
    Goncalves RM, Harris JA, Rivera DE: Biliary dyskinesia: natural history and surgical results. Am Surg 1998, 64:493–497.PubMedGoogle Scholar
  22. 22.
    Velanovich V: Biliary dyskinesia and biliary crystals: a prospective study. Am Surg 1997, 63:69–74.PubMedGoogle Scholar

Copyright information

© Current Science Inc 2006

Authors and Affiliations

  1. 1.Pediatric Gastroenterology, Hepatology and Nutrition, Department of PediatricsMedical College of Wisconsin, MACC Fund Research CenterMilwaukeeUSA

Personalised recommendations