Biliary Dyskinesia and Symptomatic Gallstone Disease in Children: Two Sides of the Same Coin?
- 221 Downloads
Despite lack of consensus criteria, biliary dyskinesia (BD) is an increasingly accepted pediatric diagnosis.
We compared patient characteristics, outcomes, and resource utilization (before and after surgery) between children with BD and symptomatic cholecystolithiasis (LITH).
Data from the electronic medical record were abstracted for children diagnosed with BD or LITH between December 1, 2002, and November 30, 2012, at Children’s Hospital of Pittsburgh.
Four hundred and ten patients were identified (BD: 213 patients, LITH: 197 patients). Patients with BD had significantly lower BMI, longer symptom duration, more dyspeptic symptoms, and were more likely to present with other symptoms. Forty-one patients (13.8 %) with BD underwent cholecystectomy despite a normal gallbladder ejection fraction (GB-EF). In 32 of these, sincalide triggered pain compared to 75 of the 155 patients with low GB-EF. After surgery, patients with BD more commonly visited gastroenterology clinics and had more GI-related hospitalizations, while emergency room visits decreased in both groups. Only the nature of biliary disease independently predicted continuing pain after surgery, which in turn was the best predictor for higher resource utilization after cholecystectomy.
A large percentage of children with BD did not meet the adult diagnostic standards. Compared to those with LITH, children with BD have more widespread symptoms and continue to use more clinical resources after surgery. These findings suggest that despite its benign prognosis, BD is increasingly treated like other potentially acute gallbladder diseases, although it has the typical phenotype of FGIDs and should be treated using approaches used in such disorders.
KeywordsBiliary dyskinesia Cholecystolithiasis Cholecystectomy Functional gastrointestinal disorders
Crohn’s & Colitis Foundation Research Fellowship Award Grant #3590.
Conflict of interest
- 17.Gurusamy KS, Junnarkar S, Farouk M, Davidson BR. Cholecystectomy for suspected gallbladder dyskinesia. Cochrane Database Syst Rev. 2009;1:CD007086.Google Scholar
- 18.Hansel SL, DiBaise JK. Functional gallbladder disorder: gallbladder dyskinesia. Gastroenterol Clin N Am. 2010;39:369–379, x.Google Scholar
- 26.Singhal V, Szeto P, Norman H, Walsh N, Cagir B, Vander Meer TJ. Biliary dyskinesia: how effective is cholecystectomy? J Gastroint Surg. 2012;16:135–140; discussion 140–131.Google Scholar
- 29.Bohman H, Jonsson U, Paaren A, von Knorring L, Olsson G, von Knorring AL. Prognostic significance of functional somatic symptoms in adolescence: a 15-year community-based follow-up study of adolescents with depression compared with healthy peers. BMC Psychiatry. 2012;12:90.PubMedCentralPubMedCrossRefGoogle Scholar
- 30.Frank L, Kleinman L, Rentz A, Ciesla G, Kim JJ, Zacker C. Health-related quality of life associated with irritable bowel syndrome: comparison with other chronic diseases. Clin Ther. 2002;24:675–689; discussion 674.Google Scholar
- 39.[12/16/2013]. ftp://cdc.gov/pub/Health_Statistics/NCHS/Publications/ICD-9/.
- 49.Dumont RC, Caniano DA. Hypokinetic gallbladder disease: a cause of chronic abdominal pain in children and adolescents. J Pediatr Surg. 1999;34:858–861; discussion 861–852.Google Scholar
- 51.Vegunta RK. Efficacy of laparoscopic cholecystectomy in the pediatric population. J Pediatr Surg. 2008;43:1418; author reply 1418.Google Scholar
- 54.Siddiqui S, Newbrough S, Alterman D, Anderson A, Kennedy A, Jr. Efficacy of laparoscopic cholecystectomy in the pediatric population. J Pediatr Surg. 2008;43:109–113; discussion 113.Google Scholar
- 55.Delgado-Aros S, Cremonini F, Bredenoord AJ, Camilleri M. Systematic review and meta-analysis: does gall-bladder ejection fraction on cholecystokinin cholescintigraphy predict outcome after cholecystectomy in suspected functional biliary pain? Aliment Pharmacol Ther. 2003;18:167–174.PubMedCrossRefGoogle Scholar
- 56.Drossman DA, Corazziari E, Delvaux M, et al. Rome III: The Functional Gastrointestinal Disorders. 3rd ed. McLean, VA: Degnon Associates; 2006.Google Scholar
- 57.Wybourn CA, Kitsis RM, Baker TA, Degner B, Sarker S, Luchette FA. Laparoscopic cholecystectomy for biliary dyskinesia: which patients have long term benefit? Surgery. 2013;154:761–767; discussion 767–768.Google Scholar
- 62.Walker SK, Maki AC, Cannon RM, Foley DS, Wilson KM, Galganski LA, et al. Etiology and incidence of pediatric gallbladder disease. Surgery. 2013;154:927–931; discussion 931–923.Google Scholar