Sometimes bile causes symptoms without gallstones being found or without inflammation of the gallbladder. Doctors then speak of biliary dyskinesia.
What is biliary dyskinesia?
The term biliary dyskinesia refers to symptoms that are not caused by gallstones or gallbladder inflammation, but are due to irritation of the gallbladder. The proverbs “My bile is coming up” or “spitting poison and bile” aptly describe an irritable gallbladder. In many cases, the complaints are related to a reduced bile flow without an organic disease being found. Medicine therefore speaks of functional complaints, as in the case of irritable stomach or irritable bowel. The technical term “dyskinesia” comes from the Greek and stands for incorrect movements, which show the main problem of these complaints. The bile ducts and gallbladder are surrounded by muscles that normally contract and relax. In bile duct dyskinesia, these muscles can become tense and interfere with the function of the gallbladder and bile ducts.
Causes
Biliary dyskinesia is most often caused by psychosomatic symptoms such as anger and stress. This causes the gallbladder and bile ducts to tighten and impair function, causing irritable gallbladder. Normally, the muscles of the bile ducts contract rhythmically and then relax. In this way, the transmission of bile to the intestine is ensured. In addition to psychological stress, food intolerances can also disrupt this mechanism. However, organic bile problems can also be hidden behind bile duct dyskinesia, which are difficult to diagnose. Very small gallstones or barely detectable gallstones can cause discomfort in sensitive individuals, but can be difficult to diagnose. Gallbladder inflammation, which is difficult to detect, can also be a cause. In addition, other diseases such as irritable stomach, irritable bowel, stomach ulcers, reflux or can cause similar complaints as an irritable gallbladder.
Symptoms, complaints and signs
Irritable gallbladder causes symptoms similar to organic gallbladder symptoms. Most often, the bile stasis causes pain under the right costal arch, which may be permanent or intermittent and may radiate to the shoulder. Painful colic may also occur with irritable gallbladder. The symptoms often occur after sumptuous and fatty meals, coffee or alcohol consumption. The intolerances manifest themselves in a feeling of fullness, flatulence and diarrhea. Oily stools may occur due to the lack of bile. The symptoms are very similar to those of gallstones. The symptoms can be mild, but can also be severe and crampy, lasting from a few minutes to several hours. Unlike gallbladder inflammation, however, the skin does not turn yellow and the stool is not discolored.
Diagnosis
If biliary symptoms are unclear, a doctor should always be consulted to clarify the cause of the symptoms. For the diagnosis, it is first important to exclude other diseases. By taking a detailed medical history, the physician can see whether there has been any history of biliary disease in the patient. He can get a picture of dietary habits and assess risk factors such as tobacco use, alcohol consumption, possible side effects of medications, allergies and exposure to stress and anger. A physical examination then takes place, during which the abdomen is palpated to detect possible indurations that may indicate disease. A blood test in the laboratory can provide information about possible gallbladder inflammation or other diseases. Gallstones or gallbladder inflammation can best be detected by ultrasound examination. If these tests do not provide a clear diagnosis, an x-ray with contrast or a computed tomography scan may be performed.
Complications
Bile duct dyskinesia causes relatively severe discomfort in the area of the liver. The pain occurs as a result of the so-called biliary congestion and may also lead to vomiting and loss of appetite.Likewise, patients suffer from the pain after eating fatty or very sweet meals, although alcohol and coffee also have a negative effect on biliary dyskinesia. It is not uncommon for flatulence and a feeling of fullness to occur as well, so that the patient’s quality of life is greatly reduced. The pain may disappear relatively quickly or persist for a longer period of time. As a rule, biliary dyskinesia can be diagnosed well, so that early treatment is possible. This is often done by changing the diet to healthy foods and by abstaining from alcohol, cigarettes and coffee. By means of a healthy lifestyle, biliary dyskinesia can be greatly reduced, so that no further complications or complaints arise. As a rule, excess weight must also always be reduced. Life expectancy is not affected if the patient’s lifestyle changes. However, if the lifestyle remains unchanged, inflammation of the pancreas may occur.
When should you see a doctor?
A doctor should be consulted as soon as physical impairments and stress develop due to a stressful life situation. If the stress in everyday life cannot be reduced or averted independently, there is a possibility that a doctor will provide the necessary assistance. If general performance drops, sleep disturbances occur or fatigue sets in, a visit to the doctor is advisable. If the affected person complains of chest pains, persistent inner restlessness or is highly irritable, the indications should be discussed with a doctor. In case of complaints such as diarrhea, constipation, flatulence or a feeling of fullness, a visit to the doctor is necessary. If the symptoms persist over a longer period of time or increase in intensity, a doctor should be consulted to clarify the symptoms. In the case of fatty stools or recurring abdominal pain, it is advisable to have a check-up visit with a doctor. If the affected person suffers from a reduction in his or her usual quality of life, a general feeling of illness, or severe changes in his or her own weight, he or she should consult a physician. Loss of appetite is considered unusual as soon as it lasts for several days or weeks. Therefore, it is advisable to consult a physician if the individual perceives that he or she is suffering from weakness, a lack of energy, or apathy due to a change in food intake.
Treatment and therapy
Therapy is based on the diagnostic findings. Because most cases are functional complaints, therapy consists mainly of symptom relief. If no organic causes are found, the physician may carefully motivate the patient to seek psychotherapeutic help. It often already helps to change the lifestyle in such a way that any stress can be better managed. Relaxation techniques and wellness treatments help to relax the autonomic nervous system. For abdominal cramps, the good old hot water bottle has always proven its worth. If lavish and fatty meals are not tolerated, the amount of food should be limited and the fat content reduced to relieve the bile. Excess weight can put pressure on the abdomen, so discomfort may also improve when excess weight is reduced. Spices such as turmeric, ginger and curry have a stimulating effect on bile flow and can be a valuable measure in food preparation. Fresh herbs such as dandelion, nettle, sorrel and yarrow also support the flow of bile. Alcohol should rather be avoided in case of bile complaints. Antispasmodic medications such as Buscopan help against severe discomfort in biliary dyskinesia, and Metamizol for more severe pain. Only rarely is surgical transection of the spincter Oddi muscle performed as part of ERCP because it increases the risk of pancreatitis.
Outlook and prognosis
The prognosis of biliary dyskinesia is favorable with the use of medical care and the active cooperation of the patient to relieve symptoms. With a change in current lifestyle, many affected individuals may already experience a significant improvement in their health. The focus is on optimizing food intake and reducing existing stressors. These are individual and must therefore be assessed and dealt with by each patient according to his or her own specifications.The use of psychotherapeutic approaches is also helpful. The healing process for most patients takes place over several months or years. This is linked to the patient’s insight and cooperation. In some cases, relief or complete freedom from symptoms may occur sooner. For a good prognosis, it is necessary to abstain from the consumption of harmful substances such as alcohol, drugs or nicotine. Abuse of medications should also be ruled out. The general lifestyle and structuring of everyday life can positively influence recovery. Good sleep hygiene, restful sleep, and attention to physical needs should be established. For many patients, cognitive changes and restructuring of the environment may be necessary. Better success is achieved by sufferers who, in addition to the treatment plan, additionally engage in relaxation procedures and use natural remedies in a supportive manner.
Prevention
Since the causes of functional complaints lie mainly in the mental sphere, sufficient times for relaxation, good stress management and a balanced lifestyle with a healthy diet are good preventive measures. The diet for bile complaints should not be too fatty. Alcohol and coffee should be enjoyed by sensitive people only in moderation, so as not to irritate the bile unnecessarily.
Aftercare
The options for aftercare are very limited for biliary dyskinesia. First and foremost, this condition must be treated properly by a physician to prevent further complications and discomfort. Only through a correct and, above all, early diagnosis and treatment of this disease can further complaints be avoided. Those affected by biliary dyskinesia are primarily dependent on relaxation. In this context, empathetic conversations with friends or family can be very helpful in alleviating the symptoms. In many cases, contact with other people affected by biliary dyskinesia can also be useful, as this leads to an exchange of information, which can make everyday life easier. Ginger or dandelion can also be helpful in relaxing the body and relieving spasms. Since biliary dyskinesia can also lead to inflammation of the pancreas, regular examinations of the body should be performed to prevent this inflammation. Whether the life expectancy of the affected person is reduced by this disease cannot be generally predicted. Patients are often dependent on psychological support in this regard.
What you can do yourself
Once biliary dyskinesia has been diagnosed beyond doubt by a specialist, there are various options for therapy. These depend on the severity of the disease. Regardless of which option the patient chooses, therapy should always be discussed with the attending physician. In severe cases, surgery is necessary. Until surgery is performed, the patient can make everyday life easier by following the doctor’s dietary recommendations. Avoiding fatty foods prevents further deterioration of the health condition. Regular light exercise and avoiding stress can help improve the overall physical condition. Thus, the patient can go into surgery in a good general condition and will recover from it more quickly in the idel case. In milder cases, surgery is not necessary. However, the patient should not decide this himself, but follow the advice of his doctor. If the typical complaints occur only from time to time, the patient can analyze his eating behavior more closely. A food diary provides a very good basis for the patient’s own observations and later discussions with the physician. Fatty foods should be avoided completely. Nutritional counseling can also help the patient to identify the right foods. Alcohol and nicotine, as well as other substances that stress the body, should be avoided.
