Any other option than cholecystectomy for biliary dyskinesia? pt doesn't fit profile. pain not bad, any ideas?

Lo fat diet: This may help but if it doesn't then surgery is a good choice

Nope: If you haven't done a CCK HIDA, consider that, but instruct the patient to pay attention as to whether or not the CCK reproduces the pain. If so, there is a growing trend to perform cholecystectomy in these patients, regardless of EF. Also consider a gastric emptying study looking for gastroparesis. Hope this helps!

Liver function tests: In order to suggest any intervention, medical or surgical, series of Lfts are needed. If they are all normal one has to remain conservative and pain be treated with common analgesics. However if there is abnormality of Lfts then radiological or sonographic evidence is required.

Try herbal: I've used herbal treatments...the more gentle ones being teas/infusions of peppermint, chicory, and lemon balm... I havent used the older 'fast/blast' treatment of a 3-4 day veggie broth fast followed by two tablespoons of olive oil...but years ago a friend did it, and it seemed to 'reset' their gb metabolism. good luck!!

FODMAP Diet: I've had several patients over the years with suspected gallbladder symptoms, some with normal and some with abnormal U/S and/or HIDA, who wanted to avoid surgery. In addition to avoiding fatty foods and anything they have discovered that aggravates the symptoms, some have noted improvement by avoiding FODMAPs as is often recommend in IBS and other functional GI issues.

Diet: I would first recommend telling the patient to change their diet, regardless of whether surgery was done. Weight loss would also be beneficial. I'd follow LFTs regularly (q3 mo e.g.) and monitor for any epigastric pain. Then, would re-image in a few months. Definitely get GI involved.

Yes: Biliary dyskinesia may sometimes be due to hypothyroidism.

Observation is ok: Biliary diskinesia can be treated with just observation. No harm with that approach. Sometimes it improves with time. You can also try antispasmodic a like bentyl (dicyclomine). If the Hida EF is close to normal or the pt gas no pain when cck was given observe for awhile and consider Egd to rule other Gi pathology.

Watch and wait?: In a study to determine the success rate of cholecystectomy vs observation in treating patients with GD vs Dyskinesia, the patients with symptoms of classic GB disease had much more success after cholecystectomy. Since patients with dyskinesia & atypical symptoms were much less likely to have improvement after surgery, observation was the recommendation. Surg Lapar Endo Perc Tech. 2009, June 19

Pain is guide: Assuming dx made via dynamic imaging of gallbladder demonstrating dyskinesia, then patient symptoms become the guide (if no other findings). When it becomes enough of an issue and dietary modifications are not helpful, then surgery. Kind of like DJD of joint. When to do surgery is when patient is no longer willing to put up with it.

See answer: I'm assuming by biliary dyskinesia your referring to Functional gallbladder disease as opposed to Sphincter of Oddi Dysfunction(SOD). There is one report in the literature showing benefit from the use of sulphate-bicarbonate-calcium-magnesium mineral water, presumably stimulating the release or modulating the activity of some GI neurohumoral regulators> http://1.usa.gov/1WZmiSx

Biliary dyskinesia: Unfortunately there is no medication hat will treat this condition. Sometimes this is also a manifestation of more severe issues. Historically about 1/3 of patients will completely better, 1/3 mostly better and 1/3 no better after cholecystectomy for Biliary dyskinesia. Sometimes these patients can also have Sphincter of Odi dysfunction but that require manometry of the sphincter to diagnose.

Consider GI evaluati: to evaluate for functional bowel syndromes. Dyskinesia implies that there is an abnormal gallbladder EF on HIDA scan but I'd say most patients I see have a normal HIDA scan and do not have classic reproduction with CCK injection. I have pts keep food journal and trial of omeprazole (for gastritis) with hyoscyamine prn abdominal pain. Check for non-dietary triggers (stress, depression, etc). G'Luck