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PubMed This is a summary of 55 peer-reviewed journal articles Updated
Gastroenterology · Functional Gallbladder Disorder

Biliary Dyskinesia (Functional Gallbladder Disorder): A Patient Guide

At a Glance

Biliary dyskinesia, also called functional gallbladder disorder, can cause real upper-abdominal pain even when ultrasound and CT scans look normal. Doctors use the pain pattern, exclusion of other causes, and sometimes a HIDA scan; gallbladder removal may help carefully selected patients.

Biliary dyskinesia, now officially classified as Functional Gallbladder Disorder, is a condition where the gallbladder fails to empty its contents correctly despite appearing healthy on standard medical imaging. Unlike more common gallbladder issues, such as gallstones or inflammation, this is a functional disorder—a problem with how the organ moves or how the nerves signal pain, rather than a structural blockage [1][2]. Because the gallbladder physically looks normal on ultrasounds and CT scans, many patients experience a long and exhausting diagnostic odyssey, often feeling dismissed as test after test comes back clear while their pain remains very real [3][4].

The cornerstone of understanding this condition lies in the nature of the pain itself, which experts categorize using the Rome IV criteria. This “typical biliary pain” is characterized by intense, steady episodes in the upper abdomen that last at least thirty minutes, are severe enough to interrupt daily life, and are not relieved by bowel movements, posture changes, or antacids [1]. While specialized tests like the HIDA scan can measure how much radiotracer the gallbladder pumps out, the most reliable predictor of whether a patient will find relief is how closely their physical symptoms match this specific pain pattern [5][6]. A low scan result alone is supportive evidence, but it is rarely enough to confirm the diagnosis by itself; instead, doctors look for a combination of clinical symptoms and the exclusion of other structural causes [7][8].

Deciding on a treatment path is a careful process of balancing the hope for relief against the uncertainty of a functional diagnosis. Laparoscopic cholecystectomy (surgical removal of the gallbladder) is one treatment option that may be considered after a specialist evaluation [9]. While this procedure helps a majority of carefully selected patients, it is not a universal guarantee. Some individuals may continue to experience pain due to underlying nerve sensitivity or other digestive issues [10][11]. Ultimately, managing functional gallbladder disorder requires a partnership with your care team to ensure that surgery is the right step and that all other potential causes for the pain have been thoroughly explored [12][13].

In this guide

6 chapters

01

Validation & Orientation: Understanding Biliary Dyskinesia

Learn why biliary dyskinesia can cause real upper-abdominal pain despite normal tests, how Rome IV criteria and HIDA scan ejection fraction guide diagnosis.

02

Defining the Pain: Symptoms & Diagnostic Standards

Learn how biliary dyskinesia is diagnosed using Rome IV pain criteria, HIDA scan results, and evaluation for ulcers, reflux, IBS, and other digestive causes.

03

The HIDA Scan: Measuring How Your Gallbladder Moves

Learn how a HIDA scan evaluates gallbladder function in biliary dyskinesia, including the 60-minute CCK protocol, EF ranges, preparation, and test limits.

04

Making the Treatment Decision: Surgery or Observation?

Learn how biliary dyskinesia treatment decisions weigh surgery, HIDA ejection fraction, pain patterns, observation, medical options, and surgical risks.

05

Building Your Care Team & First Visit Prep

Learn how to prepare for a biliary dyskinesia visit, choose GI and surgical specialists, and bring HIDA scan details, imaging, labs, and symptom logs too.

06

After Surgery: Recovery, Results, and Red Flags

Learn what to expect after biliary dyskinesia surgery, including recovery, warning signs, persistent pain, ERCP risks, and treatment for bile acid diarrhea.

Common questions in this guide

What is biliary dyskinesia, and why can scans look normal?
Biliary dyskinesia, also called functional gallbladder disorder, occurs when the gallbladder does not empty normally or its nerve signals contribute to pain. Ultrasound and CT scans may look normal because there is no visible gallstone, inflammation, or blockage.
What does biliary dyskinesia pain usually feel like?
Typical biliary pain is intense and steady in the upper abdomen and lasts at least 30 minutes. It is severe enough to disrupt daily activities and is not relieved by bowel movements, changing position, or antacids.
Can a HIDA scan confirm biliary dyskinesia on its own?
A HIDA scan measures how much the gallbladder empties. A low result can support functional gallbladder disorder, but it usually does not confirm it by itself; clinicians also consider whether the pain matches typical biliary pain and whether other structural causes have been ruled out.
Does everyone with biliary dyskinesia need gallbladder removal?
No. Laparoscopic cholecystectomy, or minimally invasive gallbladder removal, may be considered after specialist evaluation, especially when the pain pattern fits and other causes have been excluded. It helps many carefully selected patients but does not guarantee that pain will stop.
Why might pain continue after gallbladder surgery?
Some people continue to have pain after gallbladder removal because nerve sensitivity or another digestive problem may be contributing. Before surgery, ask your care team how these possibilities will be evaluated and what the plan would be if pain persists.

Get notified when new evidence is published on biliary dyskinesia.

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References

References (13)
  1. 1

    Biliary Dyskinesia and Hyperkinesis.

    Tseng J, Chen Y, McDonald C

    The Surgical clinics of North America 2024; (104(6)):1191-1201 doi:10.1016/j.suc.2024.04.007.

    PMID: 39448121
  2. 2

    The Management of Dysfunctional Gallbladder Disease and the Role of Laparoscopic Cholecystectomy on Symptom Improvement: A Retrospective Cohort Study.

    Abuahmed MY, Wuheb A, Eskandar G, et al.

    Cureus 2024; (16(7)):e64726 doi:10.7759/cureus.64726.

    PMID: 39156402
  3. 3

    Refractory Hyperkinetic Biliary Colic: A Case of Biliary Dyskinesia.

    Coe B, Elkhashab I, Haroon MA, Frasso CN

    Cureus 2026; (18(1)):e102226 doi:10.7759/cureus.102226.

    PMID: 41742966
  4. 4

    Biliary Dyskinesia with Reduced Gallbladder Ejection Fraction: A Diagnostic and Therapeutic Shift in Management.

    Elaskandrany MA, Ismail M, Liu Y, Wang WW

    Journal of Brown hospital medicine 2025; (4(1)):6-9 doi:10.56305/001c.127836.

    PMID: 40027459
  5. 5

    Cholescintigraphy may have a role in selecting patients with biliary dyskinesia for cholecystectomy: a systematic review.

    Alhayo S, Eslick GD, Cox MR

    ANZ journal of surgery 2020; (90(9)):1647-1652 doi:10.1111/ans.16003.

    PMID: 32479706
  6. 6

    Functional gallbladder disorder: Interim analysis of a prospective cohort study.

    Xu KJ, Brock JC, Goussous N, et al.

    American journal of surgery 2024; (229()):129-132 doi:10.1016/j.amjsurg.2023.12.010.

    PMID: 38110322
  7. 7

    Biliary Dyskinesia-Controversies, Diagnosis, and Management: A Review.

    Richmond BK

    JAMA surgery 2024; (159(9)):1079-1084 doi:10.1001/jamasurg.2024.0818.

    PMID: 38959007
  8. 8

    Gallbladder and Sphincter of Oddi Disorders.

    Elmunzer BJ, Winslow E, De Giorgio R, et al.

    Gastroenterology 2026; (170(6)):1303-1317 doi:10.1053/j.gastro.2026.01.035.

    PMID: 41713708
  9. 9

    Gallbladder Dyskinesia.

    Presti ME, Elwing JE, Sayuk GS

    Southern medical journal 2022; (115(11)):838-841 doi:10.14423/SMJ.0000000000001466.

    PMID: 36318951
  10. 10

    Management of gallbladder dyskinesia: patient outcomes following positive ⁹⁹mtechnetium (Tc)-labelled hepatic iminodiacetic acid (HIDA) scintigraphy with cholecystokinin (CCK) provocation and laparoscopic cholecystectomy.

    Dave RV, Pathak S, Cockbain AJ, et al.

    Clinical radiology 2015; (70(4)):400-7.

    PMID: 25588803
  11. 11

    Functional Dyspepsia and Irritable Bowel Syndrome are Highly Prevalent in Patients With Gallstones and Are Negatively Associated With Outcomes After Cholecystectomy: A Prospective, Multicenter, Observational Study (PERFECT - Trial).

    de Jong JJ, Latenstein CSS, Boerma D, et al.

    Annals of surgery 2022; (275(6)):e766-e772 doi:10.1097/SLA.0000000000004453.

    PMID: 32889877
  12. 12

    Decision-making patterns in managing children with suspected biliary dyskinesia.

    Nakayuenyongsuk W, Choudry H, Yeung KA, Karnsakul W

    World journal of clinical pediatrics 2017; (6(2)):124-131 doi:10.5409/wjcp.v6.i2.124.

    PMID: 28540197
  13. 13

    Functional Gallbladder Disorders: Are We Missing Gallstones?

    Kendric TJG, Apikotoa SA, Ng ZQ, Wijesuriya R

    World journal of surgery 2026; (50(2)):353-359 doi:10.1002/wjs.70230.

    PMID: 41506661

This page is for informational purposes only and does not constitute medical advice. Discuss your biliary pain, test results, and whether gallbladder surgery is appropriate with your healthcare team.