Evaluation and management of functional biliary pain in patients with an intact gallbladder

John K. DiBaise

Research output: Contribution to journalReview articlepeer-review

9 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)305-313
Number of pages9
JournalExpert Review of Gastroenterology and Hepatology
Issue number3
StatePublished - 2009


  • Acalculous
  • Cholecystectomy
  • Cholescintigraphy
  • Chronic cholecystitis
  • Functional biliary pain
  • Gallbladder

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology


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