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Biliary dyskinesia


Biliary dyskinesia (synonyms - biliary dysfunction, functional disorders of the biliary tract) - a group of functional diseases, the occurrence of which is caused by motor disorders of the biliary (biliary) tract.

The bile formed in the liver in a healthy person enters the hepatic ducts (left and right), then into the main hepatic duct, at the end of which there is a valve - Miritstsi sphincter (it separates the main hepatic duct from the common bile duct). Bile accumulates and concentrates in the bladder in the interdigestive period. When eating any food under the influence of hormonal and nerve signals, the bladder contracts, and the bile accumulated in it enters through the opened Lutkens sphincter into the cystic duct, and then into the choledoch (common bile duct), and from it through the sphincter of Oddi into the duodenum.

Possible motor disturbances include changes in the contractility of the gallbladder (its filling with bile or emptying) and the valve (sphincter) apparatus of the bile ducts. Bile sphincter valves are Lutkens, Miritstsi and Oddi. Of all of them, dyskinesia is more often detected in the work of the sphincter of Oddi (fibrous-muscular valve of the hepato-pancreatic ampoule), which regulates the flow of bile and pancreatic juice into the lumen of the duodenum.

Prolonged dyskinetic disorders of the biliary tract can cause gallstone disease, pancreatitis , cholecystitis.

The disease can manifest itself in any age groups and is characterized by a wavy course. As a rule, women predominate among patients.

Causes and mechanisms of development

The basis of the formation of disorders of motor coordination of the biliary tract are the following mechanisms:

  • disorders of the vegetative or central nervous regulation;
  • pathological reflexes from other parts of the digestive tract (for example, in inflammatory processes);
  • hormonal changes (imbalance in the production of sex hormones, gastrin, cholecystokinin, enkephalins, angiotensin, glucagon, etc.).

Their development can lead to:

  • abnormalities of the intrauterine development of the biliary tract;
  • psycho-emotional stress;
  • dietary errors (unhealthy diet, excess fat, etc.);
  • parasitic diseases ( opisthorchiasis , giardiasis, etc.);
  • biliary tract diseases (cholecystitis, cholelithiasis, cholangitis);
  • postoperative disorders (postcholecystectomy syndrome, conditions after vagotomy, gastric resection, etc.);
  • liver diseases (cirrhosis, hepatitis of different origin, etc.);
  • peptic ulcer disease;
  • diabetes;
  • premenstrual syndrome;
  • pregnancy;
  • myotonia;
  • hypothyroidism ;
  • celiac disease;
  • obesity;
  • hormonally active tumors;
  • somatostatin treatment;
  • use of hormonal contraceptives;
  • excessive physical exertion;
  • running or brisk walking;
  • food allergies.


Practicing doctors use different classifications of biliary dysfunctions. According to their location, they are divided into:

  • dysfunction of sphincter of Oddi (3 types: pancreatic, biliary, combined);
  • gallbladder dysfunction.

Depending on their origin, primary (without organic disorders of the extrahepatic components of the biliary system) and secondary dysfunctions are distinguished.

For functional disorders determine the following forms of biliary dysfunction:

  • hypertonic-hyperkinetic;
  • hypotonic-hypokinetic.

Symptoms of biliary dyskinesia

Despite its functional nature, biliary dysfunction gives patients a very tangible suffering that can seriously impair the quality of their normal life. Its most characteristic manifestations are:

  • pain syndrome;
  • dyspeptic syndrome;
  • neurotic syndrome.

Pain may vary depending on the type of dyskinesia. So, with the hypotonic-hypokinetic variant, they are located in the zone of the right hypochondrium, have a pulling, dull character, are quite long, decrease after eating, choleretic drugs or vegetable fees, duodenal sounding. Hypertonic-hyperkinetic type is manifested by cramping (sometimes quite intense), short-term pain, which is often provoked by food, and subsides in heat or after the use of antispasmodics. With dysfunctions of the sphincter of Oddi, repeated (for at least three months) painful attacks very much resemble biliary colic (biliary type) or pancreatic pains (pancreatic type). They may occur after eating or at night.

Dyspeptic symptoms inherent in biliary dysfunctions include nausea with vomiting (more often accompanied by a painful attack), a bitter taste, upset stool, belching, loss of appetite, bloating.

In addition, such patients are often subject to sudden changes in mood (it is reduced in the morning), they are too anxious, fixed on their condition, touchy, hot-tempered, irritable, have sleep disorders.


When examining patients, the doctor may suggest the presence of biliary dyskinesias, if palpation and tapping of the abdomen reveal pain and a zone of the right hypochondrium and positive biliary symptoms (Kera, Myussi-Georgievsky, Ortner, Vasilenko, Murphy, etc.).

However, these data alone are not enough to understand the true clinical situation. All patients should be examined. The scope of appropriate diagnostic studies is determined by the doctor. Their complex may include:

  • biochemical tests (levels of transaminases, pancreatic enzymes, bile pigments are estimated, with dysfunction of the sphincter of Oddi, a two-fold increase in alkaline phosphatase, ALT, AST during pain is possible);
  • provocative tests (morphine-choleretic, morphine-neostigmine, with cholecystokinin, with egg yolks, etc., which stimulate the contractile activity of the gallbladder or sphincters and provoke a painful attack);
  • Ultrasound (assesses the size of the gallbladder, the thickness of its walls, the nature of the contents, excludes the presence of stones, polyps, tumors, the diameter of the biliary tract, sometimes combined with traditional ultrasonography with provocative tests);
  • hepatocholecystography (a technetium radioisotope study demonstrates the rate and extent of capture of the injected radioisotope by the liver from the blood, its excretion into the bile, sequential flow of the gallbladder, extrahepatic biliary ducts, then into the duodenum, identify and determine the form of biliary dyskinesia);
  • fibroesophagogastroduodenoscopy (an indirect indicator of biliary dysfunction is the absence of bile in the duodenal cavity, endoscopic examination excludes organic changes in the area of ​​the large duodenal nipple - scars, tumors, etc.);
  • duodenal intubation (now rarely used, it allows to verify dyskinesia and determine its shape, to detect changes in the colloidal balance of bile);
  • X-ray examinations (cholecystography, cholangiography allow to evaluate the structure, concentration function and contractility of the biliary tract and gall bladder);
  • MRI cholangiopancreatography (non-contrast method with highly informative, assesses the state and functions of both intra- and extrahepatic bile ducts, gall bladder);
  • endoscopic manometry of the sphincter of Oddi (with dysfunction, an episodic or stable increase in basal pressure of more than 40 mm Hg is recorded);
  • ERCP (endoscopic procedure - retrograde cholangiopancreatography is a highly informative, but complex procedure, so it is carried out rarely and only according to indications).

Treatment of biliary dyskinesia

After establishing the primary biliary dysfunction and clarifying its type, the doctor will be able to develop the desired treatment strategy. It is based on the following blocks:

  • diet therapy;
  • pharmacotherapy;
  • physiotherapy;
  • phytotherapy;
  • surgical techniques.

In most cases, for complex treatment, patients do not need to be hospitalized.

When dyskinesias are secondary, all medical efforts should first be directed to the treatment of the underlying disease.

Diet therapy

Changing the diet is one of the key objectives of non-surgical treatment of patients with biliary dysfunction. Moreover, the correction of the usual composition of dishes and products requires an understanding and a certain patience from the patients themselves. After all, these are not immediate measures, but a long-term deliberate change in lifestyle. Only then will the diet have a beneficial effect.

Medical nutrition recommended for patients with diseases of the biliary tract, must comply with certain principles listed below:

  • fragmentation of food intake (regular ingestion of food in the digestive tract counteracts the stagnation of bile, therefore, food is considered optimal every 4 hours);
  • food should be consumed in small portions, as overeating can increase the hypertonus and provoke pain;
  • rejection of excessively cold drinks and dishes (otherwise spasm of the sphincter of Oddi may occur or intensify);
  • balanced ratio and content of basic nutrients (carbohydrates, proteins, fats), corresponding to the energy expenditure of a particular patient and his age standards;
  • with a serious stagnation of bile for three weeks, sometimes they prescribe a diet with an increased quota of vegetable fats;
  • allowed dishes are boiled and / or steamed, stewed and baked with portability;
  • half of the ration proteins must be of animal origin (fish, seafood, eggs, meat, dairy products provide an increase in bile cholates along with a simultaneous decrease in cholesterol, therefore, prevent stone formation);
  • restriction of animals of refractory fats (lamb, beef, duck, pork, goose, sturgeon, etc.), fried foods;
  • active use of vegetable oils: cotton, olive, soybean, sunflower, etc. (they increase both bile formation and bile secretion, the polyene fatty acids contained in them have a beneficial effect on cholesterol metabolism and stimulate the motility of the smooth muscles of the gallbladder), they are added to the ready-made dishes;
  • a sufficient amount of indigestible fiber, which is abundant in cereals, berries, bran, vegetables, fruits (it reduces the pressure in the duodenum, thereby improving the flow of bile through the ducts into the intestine);
  • the inclusion of vegetable juices (cucumber, rare, carrot, etc.), greatly enhancing the production of bile;
  • the exclusion of products with a high content of essential oils (garlic, radishes, etc.), smoked meats, spicy seasonings (mustard, horseradish, etc.), pickles, pickles;
  • rejection of alcoholic beverages;
  • with hypotonic-hypokinetic type of dyskinesia, a diet with an increased amount of vegetable oils and fiber is indicated, and in the case of the hypertonic-hyperkinetic variant, nutrition is prescribed with restriction of cholekinetic products (egg yolks, etc.) and the indispensable inclusion of magnesium-containing products (millet, buckwheat, vegetables, wheat bran).

In addition, patients are recommended medicinal mineral water. They enhance the production of bile, contribute to its dilution, reduce the existing congestion, affect the tone of the gallbladder. The choice of certain mineral waters is determined by the form of dyskinesia.

In the case of a hypotonic-hypokinetic variant, patients are prescribed mineral waters with medium mineralization (Arzni, Batalinskaya, Borzhomi, Truskavets, Essentuki No. 17, Jermuk, Naftusya, etc.). They are drunk in a cool form, the permissible volume reaches up to half a liter per day (it is divided into three different methods). Mineral water can not only drink, but also to enter up to 1 liter during duodenal sounding (with severe hypotension).

Hypertensive-hyperkinetic form is the reason for the reception of warm mineralized waters ("Narzan", "Slavyanovskaya", "Essentuki №20", etc.).


The selection of effective drugs is based on the type of established dyskinesia. So, if a patient is diagnosed with a hypotonic-hypokinetic form, then he will be shown:

  • prokinetics that positively affect motor activity (itopride, metoclopramide, domperidone);
  • general tonic (Eleutherococcus, tinctures of ginseng, lemongrass, aralia, etc.);
  • cholagogic:

- choleretics - liver production of bile stimulants (allohol, liobil, hologon, tsikvalon, oxafenamid, holonerton, holosas, flamin, hofitol, holaflux, cholenzyme, nicodin, hepabene, etc.);

- cholekinetics - stimulation of biliary excretion (berberine, xylitol, magnesium sulfate, sorbitol, etc.).

It should be remembered that in this case patients need to avoid antispasmodics. These remedies will further aggravate hypotension and increase pain.

Cholekinetics are often used during tubules - “blind sensing” (an additional method of treating hypotonic-hypokinetic biliary dysfunction).

Hypertensive-hyperkinetic variant should be an indication for the following medications:

  • painkillers - analgesics (baralgin, tempalgin, pentalgin, trigan D, etc.);
  • antispasmodics (mebeverin, drotaverin, othilonium citrate, benciclan, papaverine hydrochloride, pinaverium bromide, etc.);
  • choleretic: cholespasmolytics or cholelithics - drugs that relax the biliary tract (odeston, olimethin, aminophylline, etc.);
  • nitrates (nitrosorbid, sustak, nitroglycerin, etc.);
  • M-cholinolytics (Buscopan, metacin, chlorosyl, atropine, etc.);
  • benzothiazepines (diltiazem);
  • calcium channel blockers (nifedipine, halopamid, verapamil, etc.).

Regardless of the form of biliary dysfunction, many patients are recommended:

  • vegetative stabilizing agents (motherwort, Belladonna preparations, benzogeksonii, etc.);
  • psychotropic drugs (amitriptyline, melipramine, attarax, Elenium, sulpiride, tazepam, grandaxine, oretoil, etc.).


Arsenal of physiotherapeutic methods can significantly facilitate the life of patients with biliary dyskinesias. Properly selected procedures:

  • reduce pain;
  • eliminate spasm of smooth muscles;
  • normalize the tone of the bile sphincter and gallbladder;
  • stimulate the contractility of the gallbladder.

In the case of hypertonic hyperkinetic-dyskinesia forms are recommended for patients inductothermy (electrode disk is placed over the right upper quadrant), UHF, microwave therapy (UHF), high intensity ultrasound, electrophoresis novocaine, applications or ozokerite wax, galvanic, conifers, radon and hydrogen sulfide bath.

In the hypotonic-hypokinetic variant, diadynamic currents, faradization, sinusoidal modulated currents, low-impulse currents, low-intensity ultrasound, pearl and carbonic baths are more effective.

Acupuncture can normalize the biliary tract tone in any form of biliary dysfunction.


Many plants are able to activate the bile-forming ability of the liver, adjust the motor function of the sphincter apparatus and the bile ducts. They are used in the form of infusions, decoctions, extracts or syrups.

Such natural natural choleretic include pharmacy smoke, milk thistle, turmeric root, immortelle, parsley, corn silk, cumin, tansy, three-leaf watch leaves, dandelion root, yarrow, chicory, peppermint, dogrose, celandine barberry. and etc.

The roots of valerian and licorice, chamomile, dill, motherwort, steppe sage, lemon balm, and St. John's wort can have cholespasmolytic effect.


In the absence of long-awaited relief after adequate and complex conservative therapy, doctors use surgical techniques. They can be:

  • minimally invasive (often with the use of endoscopic equipment);
  • radical.

In case of identified dysfunction of the sphincter of Oddi spend:

  • injections directly into this botulinum toxin sphincter (it significantly reduces spasm and pressure, but the effect is temporary);
  • balloon dilatation of this sphincter;
  • staging of a special stent stent in the bile duct;
  • endoscopic sphincterotomy (its excision with duodenal nipple) followed by (if necessary) surgical sphincteroplasty.

An extreme measure to combat severe hypotonic-hypokinetic variant of biliary dysfunction is cholecystectomy (complete removal of the atonic gallbladder). It is carried out by laparoscopic (instead of an incision on the abdominal wall, several punctures are made for equipment and instruments) or by a laparotomic (with a traditional incision) path. But the effectiveness of this serious surgical intervention is not always felt by patients. Often after this, the renewal of complaints is associated with the developed post-cholecystectomy syndrome. Rarely carried out.


To prevent biliary dysfunction, patients are usually advised to:

  • regular meals that meet the above requirements;
  • avoid psycho-emotional overload;
  • normalization of labor;
  • stop smoking;

своевременное лечение всех других хронических недугов, так как возможно рефлекторное влияние со стороны пораженных органов на моторику желчевыводящей системы.

23 Февраль 2014 | 12 563 | Uncategorized
  • галина | November 21, 2015

    Thanks for the information.

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