Correlation of Classification of Biliary Dyskinesia by Ultrasonographic Test and Cholecystokinin

Abstract

Although functional disorder of gall bladder and duct associated with upper abdominal pain is known as biliary dyskinesia (BD), the pathophysiology of this disease remains to be elucidated and clinical daiagnostic criteria are not well established. In order to make a diagnosis of BD, I employed an ultrasonographical measurement of the size of gall bladder before and after oral administration of two egg yolks in patients who complained of right hypochondralgia without organic abnormality. Serum levels of cholecystokinin (CCK) were also examined in the same subjects. A definite diagnosis of BD was made when the size of gall bladder showed abnormal changes with reappearance of right hypochondralgia. According to patterns of gall bladder contraction, BD was classified into three groups: hypocontraction, hypercontraction, and biphagic types. Serum CCK levels did not show any difference between normal control and each types of BD before administration of yolks but significantly (P < 0.05) increased after 90 minutes in hypercontraction and biphagic types compared to the normal control. The contraction rate of gall bladder was related to the pattern of reappearance of abdominal pain. It was high in those who had the reappearance of hypochondralgia longer than an hour. In conclusion, the ultrasonographical measurement of gall bladder might be useful in diagnosing BD.