Biliary dyskinesia in the pediatric patient

Abstract

The term biliary dyskinesia commonly describes a motility disorder of the biliary tract that is divided into two main categories: gallbladder dyskinesia (GBD) and sphincter of Oddi dysfunction (SOD). SOD is further subdivided into biliary SOD and pancreatic SOD. GBD causes typical biliary colic without gallstones, whereas SOD typically presents with recurrent pancreatitis or chronic abdominal pain, usually after cholecystectomy. GBD and SOD are uncommon in children. Based on adult experience, this review discusses the diagnosis and treatment of GBD and SOD in the pediatric population.

The Etiology of Acute Recurrent Pancreatitis in Children

“…As in other series, 2Y6,8 the results of our work are influenced by the incompleteness of the collected data because of the retrospective study design as well as the bias in patient selection, the experience of the clinicians in our center, and the lack of investigation for other etiologies, as a sphincter of Oddi dysfunction and autoimmune pancreatitis. 38,39 In conclusion, our data confirm that recurrent pancreatitis in pediatric age is a complex disease in which structural and genetic factors play a major role than the environment. 40 Early recognition of the etiology involved is important because it may favor a complete resolution of the disease (biliopancreatic malformations or gallstones) or prevent complications in other organs in late-onset CF patients.…”

Biliary Dyskinesia: How Effective is Cholecystectomy?

“…[2][3][4][5] This finding has been described in the pediatric population as well. [6][7][8][9][10][11] Some recent studies have questioned the predictive value of gallbladder ejection fraction and have suggested that the reproduction of symptoms with cholecystokinin is more likely to predict symptomatic relief from cholecystectomy. 12,13 The encouraging results from these studies, however, are based on short-term surgical followup.…”

Pediatric Gallbladder Dysmotility: Not as Rare as Previously Considered; a Case Report and Review of Literature

“…Laparoscopic cholecystectomy has been the standard treatment for GBD in recent years; however, not all patients benefit from cholecystectomy. Previous studies have reported a wide range of satisfaction rate from 34% to 100% in patients undergone this surgery (9,15). With regards to the prediction of pain improvement in patients undergoing surgery, there is evidence suggesting that the symptoms and duration of them can predict cholecystectomy outcomes in patients.…”

“…There are some occasions where organic etiologies of chronic abdominal pain could not be distinguished from functional etiologies. This may often occur in children, especially those with lower ages that are not able to properly localize pain; thus, the diagnosis of such dysfunctions may be more difficult and lead to longer periods of workup and delayed diagnosis (9). Additionally, studies suggest that some abnormalities that are being diagnosed and assumed to trigger the symptoms may not be the main reason behind the presented symptoms (4); therefore, proper evaluations to find the underlying cause(s) of the pain are essential.…”