Clinical Predictors of Gallbladder Dyskinesia

Abstract

Introduction: Gallbladder dyskinesia (GD) is defined as biliary pain in the absence of gallstones. The diagnosis relies on cholecystokinin-stimulated cholescintigraphy (HIDA) to show decreased gallbladder ejection fraction (GBEF). There are no well-defined clinical parameters for predicting gallbladder dyskinesia in patients presenting with abdominal pain suspicious of gallbladder dysmotility. The aim of this study is to assess the clinical predictors of gallbladder dyskinesia in a cohort of patients with abdominal pain and no evidence of gallstone undergoing HIDA study. Methods: A prospective study of patients with the chief complaint of abdominal pain and negative abdominal ultrasound for gallstone disease who were referred by their physicians for HIDA scan from January 2013 to May 2014. Patient demographics, medical and surgical history, drug use (affecting GI motility), proton pump inhibitor use, and other diagnostic tests were collected. All patients answered validated PAGI-SYM and PAC-SYM questionnaires. Following an overnight fast, all patients underwent a standardized CCK-stimulated HIDA study. Calculated GBEF of less than 35% was considered abnormal. A univariate and multivariate logistic regressions model was used to identify independent predictors for gallbladder dyskinesia and p<0.05 was considered significant. Results: From 169 patients who had been referred for HIDA study between January 2013 to May 2014, 67 agreed to participate in the study. Participants recruited to the study had a mean age of 43 years, 67% females, 73% Caucasians, average BMI 29 kg/m2, 28% smokers, and 32% alcohol users. Overall symptom frequency was as following: upper abdominal pain 100%, nausea 70%, constipation 45%, bloating 34%, vomiting 5%. Among participants, 34 (51%) patients had gallbladder dyskinesia on HIDA study. Constipation and narcotic medication use were significant predictors for delayed GBEF on HIDA study on univariate analysis. Patients with gallbladder dyskinesia were more likely to take narcotic pain medications compared to patients with normal gallbladder ejection fraction. Constipation symptom score (PAC-SYM total score) of 3.1±0.6 was associated with low GBEF, compared to score of 1.2±0.7 in patients with normal GBEF (p<0.05). Severe constipation was the only predictor of gallbladder dyskinesia on multivariate analysis. Conclusion: In a cohort of patients presenting with biliary pain and negative sonographic findings of gallstones, severe constipation could predict gastroparesis. Larger pool of data is needed to confirm these findings.