# IBS/HIDA Scan/Biliary Dyskinesia



## MomCab (Nov 29, 2002)

I've spent another frustrating day.My HIDA scan showed a 21% ejection rate so I was referred to a surgeon.I saw him today and he said the gastro thinks "biliary dyskinesia" but he's not convinced.He wants another ultra sound for gall stones and if it shows nothing a CT scan. I could cry.He asked if I've tried Bentyl for the IBS but I can't because I have glaucoma.Anyone else ever heard this from their Dr.? I am now worried sick that this is something very serious and am on the road to disasterous news.A CT scan scares me to death. The URQ pain persists. Anyone?


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## MariaM (Jan 19, 2003)

I hope everything will be okay for you. I would be interested to know what you find out because a gastroenterologist I saw for a second opinion diagnosed me with "biliary diskinesia." He didn't seem very concerned so I assumed it was just another aspect of a "functional GI disorder." However, I've started have more episodes where I have localized pain under the right rib cage. The area is tender to the touch when the pain occurs, so I'm a little worried.


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## MariaM (Jan 19, 2003)

I forgot to add that I have read that gall bladder pain/spasms can sometimes be caused by food allergies. This is something I'm going to look into since the tests I've had indicate no sign of gallstones.


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## LaurieJ (Sep 3, 2002)

Biliary dyskinesis is another name for sphincter of Oddi dysfunction. There are lots of references on the web about this. I have just been diagnosed with this and will be having an ERCP manometry done this summer or fall. From what my GI doc told me, it consists mainly of pain but no harm is being done to any organs -that is, once a physical blockage has been ruled out (if there is a blockage then it is not biliary dyskinesis but rather biliary obstruction). If indeed, it is a gallstone, stricture or mass that is causing the biliary problem then there is something that the docs can go in and do about it. Basically the dyskinesis just means that for some reason your sphincter is spasming and causes intermittent blockage of bile which causes the pain. Hope this information helps a little....very frustrating to know that you are having so much pain but there is nothing really wrong, other than a muscle spasm in the common bile duct.My understanding is that the treatment to fix dyskinesia is risky (sphincterotomy), the diagnostic procedure is controversial (ERCP manometry) and the disorder itself is debated as being "real".


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## MomCab (Nov 29, 2002)

Thanks so much for responding.I had my second gallbladder ultrasound on Tuesday and am scheduled for a CT scan on Monday.I still have terrible pain URQ and am happy to receive information on the biliary dyskinesia. My pain too, is under my right ribcage. The surgeon said removing my gallbladder (no stones) may or may not help the pain...sort of a shot in the dark,some people get relief...others not. Not a chance I'm willing to take just yet. He gave me a low fat diet (I can't eat most of the foods on the list for fear of increasing pain) and also a pain pill which made me feel horrid (Lortab).I am at my wit's end. I'll keep you posted,send good thoughts and prayers...


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## StormTrackr (Sep 8, 2002)

Hi Momcab;I too had a HIDA CCK; and my results was 4.5% ejection fraction after 30 mins. My surgeon doens't want to take mine out for fear it will upset my incontenence and D. I hope everything works out for you. Keep us posted.


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## MomCab (Nov 29, 2002)

I had my CT scan today and am thrilled to report it was negative! Upper abdomen and pelvis. I am so relieved. Now, the biliary dyskinesia and IBS are what I am left with. I will see my surgeon again soon and we must make decisions. Gallbladder removal seems so "iffy".I am having MUCH pain tonight and wonder if it's from the barium I had to ingest today.They gave me nothing post-scan to "rid" myself of the barium. Is this common? Has anyone had a gallbladder removed,had no stones and felt better?Thanks for the support. It really means something to me.


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## LaurieJ (Sep 3, 2002)

MomCab,I could be mis-interpreting the information that I have been reading but my impression with the biliary dyskinesia is that the first step in curing the pain is to remove the gall bladder. Sometimes this stops the pain completely, sometimes it does for a while and the pain comes back, and sometimes the pain never goes away. The literature says that the more "textbook" that the pain is to typical gallbladder disease, the more likely the surgery will work; the more untypical or vague that the symptoms are, the less likely the surgery will stop the pain. Most medical people tend to think of SOD as occuring only after the gallbladder surgery, but cases have been known to happen with an intact gallbladder. Your physical signs and symptoms will determine what diagnostic class that you fit in and what therapy will be offered. Just remember, that a surgeon will tend to push surgery as treatment, while a GI will lean towards medical intervention (drugs that affect your bile, or muscle relaxants to stop muscle spasms, pain meds, etc)If the surgery is perfomed and the pain remains or comes back, then the docs really start thinking SOD, and depending on the diagnositic class that you fit into may try medication or ERCP SOD manometry with sphincterotomy as therapy.Some really good literature can be found on this. A good starting point is "Sphincer of Oddi Dysfunction: Diagnosis and Treatment" by Stuart Sherman and Glen Lehman. on www.joplink.net - Vol.2, No.6 - November 2001.Dr Sherman seems to be an authority on this disorder and searching the web using his name and linking with sphincter of Oddi turns up many publications.But please remember, I am just an interested sufferer myself, and I may be in error with my conclusions - keep a healty skepticism - but I am happy to discuss this with you at anytime.My personal feelings? for what they are worth? Is that you have to weigh how much this is interferring with your life with the knowledge that the surgery could make things worse. If you are feeling that things could not be worse then it is probably worth thinking about surgery. Because if things do get worse, then you deal with it at the time - there are options. Sometimes you just have to do what you think is the best thing at the time. I regret having my surgery but realize that I had no choice - it was life threatening. Yes, I am worse than I was prior to the surgery, but if it wasn't done at the time, I would be dead now. So you deal with the side effects the best you can, realizing that you had to make the choice at the time with the information / conditions that you were experiencing when the choice was made. No looking back.Good Luck with your decision making and I let me know if there is more information that I can offer.Laurie(I am glad that your tests went well for you)Two more really good articles about this:"What is the role of ERCP in the setting o abdominal pain of pancreatic or biliary origin (suspected sphincter of Oddi dysfunction )?Stuart Sherman, MD http://home.mdconsult.com/das/article/body...html#R129016011 in Gastrointestinal EndoscopyVolume 56 Number 6 December 2002.(This one is good but may not be accesible without consent)and "Functional disorders of the biliary tract and pancreas"E Corazzizri, EA Shaffer, WJ Hogan, S Sherman, J Toouliin Gut 1999; 45 (suppl II) II48-54In my opinion, this one of the better articles that explains the whole thing.


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