title: Evaluation and management of functional biliary pain in patients with an intact gallbladder.
abstract: The diagnosis and management of suspected functional biliary pain in patients with an intact gallbladder remains contentious. Major issues include the lack of a clear definition of what constitutes biliary pain, a poor understanding of its natural history and pathophysiology, and the all too common scenario of the patient who has persistent pain despite surgical removal of the gallbladder. As a consequence, symptoms alone have generally been considered to be unreliable in the diagnosis of gallbladder dysfunction, and this has led to a search for a reliable test to help confirm a clinical suspicion of gallbladder dysfunction prior to the definitive treatment, cholecystectomy. At present, cholecystokinin-cholescintigraphy with a calculation of the gallbladder ejection fraction is the most commonly used test; however, its utility in predicting symptom outcome after cholecystectomy has been questioned. The use of cholecystokinin-cholescintigraphy to determine the appropriateness for cholecystectomy appears to be most useful when performed using a slow infusion of cholecystokinin in a well-selected patient population. However, for reasons explained herein, consideration of cholecystectomy on the basis of high clinical suspicion after adequate follow-up with trials of pharmacological therapies and exclusion of other disease entities, together with counseling the patient on postoperative expectations, may be a reasonable alternative.
authors.affiliation: Professor of Medicine, Division of Gastroenterology and Hepatology, Scottsdale, AZ 85259, USA. dibaise.john@mayo.edu
authors.forename: John K
authors.initials: JK
authors.lastname: Dibaise
mesh_terms: D001659:Biliary Tract / Q000000981:diagnostic imaging / Q000503:physiopathology; D002763:Cholecystectomy; D002765:Cholecystography; D005705:Gallbladder Diseases / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D010146:Pain / Q000175:diagnosis* / Q000000981:diagnostic imaging; D018579:Patient Selection; D011877:Radionuclide Imaging