Biliary motility

Abstract

Alterations of bile tract motility may affect the function of the gallbladder, the cholcystocystic junction and the sphincter of Oddi. Motor disorders of the biliary tract may be primitive, may accompany structural alterations but have no effect, or may complicate or be causative factors of organic abnormalities. Bile stasis within the gallbladder may occur for absent/inadequate contraction of the gallbladder or for obstruction of the cholecystocystic junction; accelerated emptying and impaired filling of the gallbladder may underlie other clinical conditions. Dysfunction of the sphincter of Oddi can be caused by sphincter stenosis or dyskinesia. Altered biliary motility is usually suspected on the basis of symptoms and tests (such as serum biochemistry, oral cholecystography, ultrasonography, cholangiography) which offer qualitative information; indirect evidence of biliary motor dysfunction can be obtained from non-invasive tests such as fatty meal ultrasonography and computerized cholescintigraphy. Manometry of of the sphincter of Oddi is the test which identifies sphincter dysfunction and differentiates stenosis from dyskinesia. When a biliary motor dysfunction is suspected, differentiated diagnostic algorithms should be followed in patients with or without gallbladder function.