What is biliary dyskinesia symptoms. Treatment of biliary dyskinesia

06.11.2020

Biliary dyskinesia - this is the presence in a person of a whole complex of certain disorders of the biliary system, which occur in connection with violations of the motor function of the gallbladder and bile ducts. At the same time, there are no organic changes in these organs. Patients very often have either too strong or insufficient contraction of the gallbladder.

Medical practice indicates that women are more susceptible to the occurrence of dyskinesias. There is evidence that biliary dyskinesia in women occurs 10 times more often than in men. With biliary dyskinesia, it does not enter the duodenum in sufficient quantities, as a result of which the patient experiences pain in the right hypochondrium. Dyskinesia is usually divided into hyperkinetic (if the condition provokes too high contractile activity of the biliary system) and hypokinetic (if the condition provokes too low contractile activity of the biliary system). It is noted that the incidence of hyperkinetic dyskinesia is more often observed in young people, and hypokinetic dyskinesia is typical for those who are already forty years old, and it also develops in people who suffer from mental instability.

Causes of biliary dyskinesia

Almost always, dyskinesia is diagnosed as a secondary disease. It manifests itself in humans as a consequence of some factors leading to disruption of the biliary tract.

So, the disease occurs in people who suffered at one time acute viral hepatitis , neurocirculatory dysfunction . In children, dyskinesia may develop due to some features of the constitution of the child, with vegetative , with a too sedentary lifestyle, due to, pathologies of the gastrointestinal tract , in the presence of foci of infection in the body. In addition, the development of biliary dyskinesia can be affected by malnutrition, a number of endocrine diseases. As a rule, with an immobile lifestyle, asthenia, and malnutrition, the patient develops hypokinetic dyskinesia.

Biliary dyskinesia in children and adults is considered as a psychosomatic disease that can be provoked by mental trauma, as well as strong ones. It has been proven that the motor activity of the gallbladder directly depends on stress and strong negative emotions: in this case, it slows down significantly, and stagnation of bile occurs in the gallbladder. Very often, when studying the case histories of such patients, it turns out that they had psychological problems of a diverse nature at one time.

In addition, the trigger for the development of dyskinesia of the gallbladder can be impaired nervous regulation of the gallbladder, period, insufficiency of the function of the endocrine glands.

There is also the possibility of attaching dyskinesia to,. In patients with peptic ulcer , there is a reflex occurrence of hyperkinetic dyskinesia. This form of the disease also threatens those who eat irregularly, too often eat very spicy foods that irritate the mucous membrane.

The main symptoms of biliary dyskinesia appear depending on which factor provoked the development of dyskinesia. As a rule, most people suffering from this disease complain of a complex of symptoms of nervosa. This is too high a level of fatigue, bouts of tearfulness and irritability, palpitations, sweating, recurrent headaches. In this case, patients feel pain in the right hypochondrium. If it's about hypertensive dyskinesia , then such pain is distinguished by paroxysmal character. In this case, the pain is quite acute, but lasts a short period of time. Pain may radiate to the right shoulder or shoulder blade. Especially often such attacks occur after eating fatty foods, strong stress, both physical and emotional. Very often, patients with hypertensive dyskinesia note a manifestation, which most often happens in the morning.

If the patient is suffering from symptoms hypotonic dyskinesia , then this condition is characterized by dull and aching pain, in which there is also a feeling of fullness in the region of the right hypochondrium. Such pain constantly worries the patient, while his appetite noticeably decreases, the person often feels sick, and belching appears. The rise in body temperature is not observed, a clinical blood test also does not indicate the presence of abnormalities.

In addition, symptoms of biliary dyskinesia in men may include decrease in sexual activity . At the same time, women may experience monthly cycle . Common signs of dyskinesia are depression, emotional as well as physical weakness. During an attack biliary colic the patient may have a feeling of a strong heartbeat or a feeling of cardiac arrest. He may be accompanied by a feeling of fear, numbness of the limbs.

The disease continues for a long period, with severe exacerbations periodically observed, which provoke stress and other elementary disorders. After the attacks, there is a periodic relief of the condition. Over time, dyskinesia can cause inflammation in the gallbladder and ducts, and cause gallstones to form.

Diagnosis of biliary dyskinesia

To accurately determine the form of dyskinesia, an ultrasound examination of the abdominal cavity is performed, as well as contrast cholecystography. A laboratory blood test is ordered. To determine what changes in the contractile activity of the biliary tract function take place (too high or too low), the patient is prescribed duodenal sounding or ultrasound, before which it is important to consume a choleretic breakfast.

Treatment of biliary dyskinesia

It should be borne in mind that the treatment of biliary dyskinesia directly depends on what causes provoked the manifestation of this disease. When prescribing therapy, it is necessary to take into account the fact that dyskinesias are classified as psychosomatic diseases. Therefore, psychotherapeutic measures are important in their treatment. However, such treatment can only be prescribed by a specialist psychotherapist. Patients, on the other hand, consider their problems to be exclusively somatic, therefore they rarely turn to a doctor of this profile. If the patient has symptoms of a depressive state, then the patient is often prescribed a course of treatment. tranquilizers , antidepressants , light preparations antipsychotics .

All further methods of treating dyskinesia directly depend on which form of the disease is diagnosed in the patient. If a patient has developed hypokinetic dyskinesia, he should observe a special one, including products with a choleretic effect and with a high content of certain minerals.

In the process of therapy, patients are prescribed regular use of mineral waters of a certain type. They need to drink one glass about three times a day, about half an hour before meals. In addition, with biliary dyskinesia, the use of massage and physiotherapy exercises is effective. Periodic spa treatment is also recommended. Sometimes it is advisable for the patient to prescribe duodenal sounding in order to free the gallbladder from bile. There is also the so-called "closed tubage" technique, which the patient can undertake independently, thus stimulating the contraction of the gallbladder.

If the patient suffers from the manifestation of hyperkinetic dyskinesia, then it is important for him to adhere to a diet that is characterized by restriction of irritant products, fats. To eliminate acute conditions, patients are shown the use of antispasmodic drugs, mineral waters. Surgical methods in this case are not effective.

In general, to improve the condition of patients, it is recommended to normalize the diet, rest and work, to exclude a number of products from the diet. You can also use some folk remedies, in particular herbal decoctions. For the treatment of dyskinesia, decoctions of coriander, anise, corn stigmas, St. John's wort, mint, sage, celandine, valerian root, immortelle grass are used. Traditional medicine also recommends drinking grapefruit juice some time before meals.

The doctors

Medications

Diet, nutrition for biliary dyskinesia

Despite the fact that biliary dyskinesia is an ailment that is not classified as a dangerous disease, dieting is extremely important to prevent further development. cholecystitis and other dangerous diseases. observed depending on which form of the disease occurs. However, in general, nutrition should contribute to the normalization of the motor functions of the biliary tract. If the patient suffers from manifestations of hypertensive dyskinesia, he needs to very sharply reduce the content in the diet of those products, the use of which helps to reduce the gallbladder. In this case, we are talking about too rich broths, animal fats, vegetable oils. But not very rich broths, fish soup, vegetable oils, dairy products make up the diet with the development of hypotonic dyskinesia.

The diet for biliary dyskinesia, which is hypertonic in nature, excludes the use of smoked, fried foods, alcohol, and spicy foods. Do not eat ice cream and drink carbonated drinks. Such food can provoke a severe spasm of the biliary tract. It is important to always eat only warm and fresh food. The diet should be a lot of vegetables, but it is desirable to limit the number of meat dishes. It is necessary to adhere to such dietary habits for a long time.

It is necessary to take food in small portions, doing this up to 6 times a day. It is advisable to eat a light meal right before bedtime. In general, the diet for this disease is similar to the principles of nutrition in the Mediterranean countries: it is dominated by vegetables, fruits, fish dishes. By the way, bran has a very good effect on the state of motility of the biliary tract: they should be taken by adding 1 tablespoon to everyday meals.

Prevention of biliary dyskinesia

In order to prevent the manifestation of this unpleasant ailment, one should, without delay, treat all disorders of a neurotic nature, avoid serious stressful situations, eat regularly, at the same time every day. More important is also a normal, full sleep and rest.

Intestinal dyskinesia

A variety of disorders of the large intestine of a functional nature are ailments that are very widespread today. (this disease is also called irritable bowel syndrome , spastic colitis ) is a condition in which the motor function of the intestine is impaired. To a greater extent, dyskinesia of the large intestine is manifested, to a lesser extent - dyskinesia of the small intestine. At the same time, organic lesions are not typical for this disease. In patients with intestinal dyskinesia, pain is manifested, their bowel function noticeably changes. In some cases, there is also too high a level of mucus secretion: a similar phenomenon is typical for about half of all patients.

Intestinal dyskinesia develops as a consequence of some neurotic disorders, serious stressful situations, conflicts, dystonia of the autonomic nervous system, and endocrine disorders. Also, a factor influencing the manifestation of intestinal dyskinesia is a hereditary predisposition to this disease. As in the case of biliary dyskinesia, this disease may manifest both hyperkinetic (spastic) and hypokinetic (atonic) changes. Quite often, both types of these disorders occur simultaneously.

A patient with progressing intestinal dyskinesia is very often concerned about pain in the abdomen, which is characterized by the absence of a clearly defined localization. There may also be disorders of the stool, too active production of mucus. The pain can have different intensity: sometimes there is a feeling of pressure in the lower abdomen, pressure in the lower abdomen, sometimes quite severe colic. They can last for several minutes or several days. Quite often, patients perceive such colic as the beginning of an attack of appendicitis. In some cases, it even comes to surgery for suspected appendicitis. Sometimes patients with intestinal dyskinesia note a periodic alternation of constipation and diarrhea. Especially often diarrhea overcomes a person in the morning, after he has taken food. In this case, feces with mucus impurities often come out.

Diagnosis of intestinal dyskinesia involves, first of all, the exclusion of possible organic ailments, the symptoms of which are similar to those of dyskinesia. The patient is scheduled for endoscopy, which reveals hyperemia of the mucous membrane of the colon. Microscopic examination of stool shows no changes.

It is important for all patients to maintain a healthy lifestyle, to avoid. If a person constantly manifests himself, he is recommended to introduce whole grain cereals, sour-milk products, baked apples into the diet.

List of sources

Sherlock S. Diseases of the liver and biliary tract / S. Sherlock - M .: GEOTAR-MED, 2002;
Diseases of the liver and biliary tract: A guide for physicians / Ed. V.T. Ivashkin. - M., 2002;
Ilchenko A.A. Cholelithiasis. Moscow: Anaharsis, 2004;
Maev I.V., Samsonov A.A., Salova L.M. Diagnosis and treatment of diseases of the biliary tract: Textbook. - M .: GOU VUNMTs of the Ministry of Health of the Russian Federation, 2003;
Ilchenko A.A. Diseases of the gallbladder and biliary tract: A guide for physicians. M.: Ana-harsis, 2006.

Biliary dyskinesia is a disease of the gastrointestinal tract, which is characterized by a violation of the motility of the gallbladder and the functions of its sphincters, in particular, the sphincter of Oddi. As a result of these disorders, problems are found with the delivery of bile to the duodenum: its amount may be too small, not enough to digest food, or more than necessary, which negatively affects the entire gastrointestinal tract.

According to statistics, women suffer most from biliary dyskinesia. Some statistics indicate that women are 10 times more susceptible to this disease than men. Moreover, you can get sick with dyskinesia at any age. There are also statistics, JVP in young people is characterized by excessive secretion of bile, and at a more mature age there is a lack of bile for digestion. The treatment of this disease has positive prognosis if the patient consults a doctor at the first symptoms.

What it is?

Biliary dyskinesia - functional disorders of the tone and motility of the gallbladder, bile ducts and their sphincters, manifested by a violation of the outflow of bile into the duodenum, accompanied by the appearance of pain in the right hypochondrium. At the same time, there are no organic changes in these organs.

Classification

It is on how the contraction of the gallbladder occurs that the definition of the form of dyskinesia also depends:

Depending on the cause of the development of the pathology in question, doctors can divide it into two types:

Causes

Speaking about the causes of dyskinesia, it must be remembered that the disease is primary and secondary. Depending on this, the reasons that provoked dyskinesia will also change.

The primary form of dyskinesia can be caused by the following reasons:

inconsistency in the work of the parasympathetic and sympathetic parts of the nervous system, as a result of which the bladder itself and the sphincter of Oddi lose their tone;
stresses (acute, chronic), development of psychosomatic pathologies;
malfunctions in the liver, as a result of which bile with an altered chemical composition is produced;
malnutrition (overeating, eating too much fatty foods, untimely breakfasts, lunches and dinners);
violations of the production of intestinal hormones responsible for the contractility of the gallbladder;
non-systematic eating, eating too fatty foods, overeating, insufficient food grinding, eating in a hurry, etc .;
allergy, as a result of which the neuromuscular apparatus of the gallbladder is in an irritated state and does not provide normal contractions of the organ;
underweight, sedentary lifestyle, muscular dystrophy.

Causes of secondary dyskinesia may include the following:

a history of chronic diseases of the abdominal organs - ovarian cyst, pyelonephritis, adnexitis, etc.;
previously transferred duodenitis, peptic ulcer, gastritis, atrophy of the mucous membrane of the gastrointestinal tract;
helminthic invasion;
cholelithiasis, hepatitis, cholangitis, cholecystitis;
congenital anomalies of the biliary tract and gallbladder;
endocrine disorders, hormonal surges;
inflammatory diseases of the gastrointestinal tract caused by pathogenic bacteria, for example, salmonella.

There are recorded cases of diagnosing biliary dyskinesia against the background of a sedentary lifestyle, excess weight (obesity stage 2-3), excessive physical exertion (especially if weights are constantly rising) and after psycho-emotional breakdowns.

Symptoms of biliary dyskinesia

The clinical picture of the described pathology is quite pronounced, so the diagnosis is not difficult for specialists. The main symptoms of biliary dyskinesia in adults are:

Dyspeptic syndrome is characterized by nausea, bitterness and dryness in the mouth, belching with a bitter taste, bloating, unstable stools with a predominance of constipation or diarrhea, fatty stools. Such symptoms are caused by violations of the digestive processes associated with insufficient or excessive flow of bile into the intestinal lumen.
Pain syndrome. The occurrence of pain is due to errors in the diet or stressful situations. In the hyperkinetic form of dysfunction, the patient is disturbed by spastic pains in the right half of the abdomen under the ribs, radiating to the left half of the chest, into the shoulder blades or taking on a girdle character. With the hypokinetic form of pain, they are bursting, pulling, with or without irradiation, intensifying or disappearing with a change in body position. Pain can disappear on its own and reappear at different intervals - from several attacks a day to rare episodes throughout the month.
Astheno-vegetative syndrome is characterized by weakness, increased fatigue, a feeling of constant weakness, drowsiness or insomnia, an increased level of anxiety and other signs.
Cholestatic syndrome rarely occurs with a hypokinetic variant of dyskinesia, when bile that continues to be produced normally does not enter the intestine in the proper volume, but accumulates in the gallbladder, leading to the appearance of yellowness of the skin and sclera, skin itching, dark urine and light feces, enlargement of the liver.
Symptoms of neurosis - panic attacks, phobias (fears), obsessive thoughts, obsessive actions, aggression, anger, tearfulness, resentment, etc.

If the patient suffers from manifestations of hypotonic dyskinesia, then this condition is characterized by dull and aching pain, in which there is also a feeling of fullness in the right hypochondrium. Such pain constantly worries the patient, while his appetite noticeably decreases, the person often feels sick, and belching appears. The rise in body temperature is not observed, a clinical blood test also does not indicate the presence of abnormalities.

If we are talking about hypertensive dyskinesia, then the pain is paroxysmal in nature. In this case, the pain is quite acute, but lasts a short period of time. Pain may radiate to the right shoulder or shoulder blade. Especially often such attacks occur after eating fatty foods, strong stress, both physical and emotional. Very often, patients with hypertensive dyskinesia note a manifestation of bitterness in the mouth, which most often happens in the morning.

Possible Complications

As a rule, with biliary dyskinesia, patients seek help from doctors almost immediately after the first attack of pain. But many of them, having removed unpleasant symptoms, stop the prescribed treatment, thereby provoking the development of complications:

duodenitis - an inflammatory process on the membrane of the duodenum;
the formation of stones in the gallbladder and its ducts - cholelithiasis;
chronic cholecystitis - inflammation of the gallbladder that lasts more than 6 months in a row;
atopic dermatitis - a skin disease that is a consequence of a decrease in the level of immunity;
chronic pancreatitis - inflammation of the pancreas for 6 months.

Biliary dyskinesia has a fairly favorable prognosis and does not reduce the patient's life expectancy. But in the absence of a full-fledged treatment and non-compliance with the recommendations of a nutritionist, the development of the above complications is inevitable. And even these diseases are not dangerous for human life, but the patient's condition will deteriorate significantly, eventually leading to disability.

Diagnostics

A significant role in the diagnosis is played by instrumental examinations of the patient. The most effective results are given by duodenal sounding, ultrasound, gastroduodenoscopy, cholecystography.

Ultrasound examination for biliary dyskinesia is carried out in two stages. First on an empty stomach, and then again 30-40 minutes after the "trial breakfast". As a result of such procedures, the functionality of the biliary tract is analyzed.
Duodenal sounding is carried out using a special probe that is placed in the duodenum. During the study, bile samples are taken for laboratory analysis. During manipulations, the work of the biliary tract is monitored, the opening of their sphincters, the amount of bile secreted is analyzed.
Peroral cholecystography. During the study, the patient drinks a contrast agent. When it enters the bladder, a study of its functioning is carried out, on the basis of which it can be concluded which form of dyskinesia manifests itself in the patient.
Gastroduodenoscopy is carried out using a probe. During this procedure, the condition of the mucous membranes of the esophagus, stomach and duodenum is analyzed. If the mucosa of these organs is in a state of inflammation and irritation, then we can conclude that there is an excess secretion of bile acids.
Laboratory methods: a biochemical blood test is used to assess the state of the biliary system. A blood test for a lipid spectrum, or "lipidogram" shows the content of high, low and very low density lipoproteins (HDL, LDL, VLDL), as well as cholesterol.

It is also necessary to carry out a differential diagnosis of the disease with other pathologies of the gastrointestinal tract, in which similar symptoms are noted.

How to treat biliary dyskinesia?

In adults, treatment should be comprehensive, aimed at normalizing the outflow of bile and preventing its stagnation in the gallbladder.

For this, the following methods are used in the treatment of biliary dyskinesia:

Dieting (table number 5);
Normalization and maintenance of the regime of work and rest;
Reception of mineral waters;
Physiotherapy (electrophoresis, diadynamic currents, paraffin applications);
The use of closed tubes and duodenal sounding;
Acupuncture;
Massage;
Sanatorium treatment (Truskavets, Mirgorod, Transcarpathian resorts of Ukraine);
Taking medications that normalize the outflow of bile, relieve pain, relieve spasm of sphincters and eliminate painful symptoms (enzymatic, choleretic, antispasmodics);
Taking medications that normalize the state of the nervous system (sedatives, sedatives, tonics, etc.).

Mandatory methods of treating dyskinesia are the normalization of the regime of work and rest, diet, medication and the use of tubes. All other methods are auxiliary, and can be applied at will and if possible. The duration of the application of mandatory methods of treatment of dyskinesia is 3-4 weeks. Auxiliary methods can be used much longer, periodically repeating courses in order to prevent the recurrence of the disease.

Medicines

Since dyskinesia refers to diseases caused by a violation of nervous regulation, it directly depends on the state of the psyche, before starting the treatment of motor activity disorders in the biliary tract when using choleretic drugs, it is necessary to restore the mental background of the patient. If the pathology appeared against the background of a depressive state, it is necessary to prescribe a course of light antidepressants. If the violation of the process of bile secretion was caused by severe anxiety, neuroses, then it is advisable to start with neuroleptics and tranquilizers.

Such drugs can be prescribed by a psychiatrist or a psychotherapist. In addition, the causes of dyskinesia are treated: correction of dysbacteriosis, elimination of hypovitaminosis, treatment of allergies, antihelminthic therapy.

The choice of drugs to restore the functions of bile formation and bile secretion depends on the type of dyskinesia.

With a hypotonic type of biliary dyskinesia, flamin, cholecystokinin, magnesium sulfate, pancreozymin are prescribed; mineral waters of high mineralization (Essentuki 17, Arzni and others, at room temperature or slightly warmed up 30-60 minutes before meals, depending on the secretion of the stomach). Phytotherapy: corn stigmas, immortelle flowers, chamomile, nettle leaves, rose hips, St. John's wort, oregano.
With hypertensive type of biliary dyskinesia, oxafenamide, nikodin, mineral waters of low mineralization (Slavyanovskaya, Smirnovskaya, Essentuki 4, 20, Narzan in hot or heated form 5-6 times a day) are used. For herbal medicine, chamomile flowers, peppermint, licorice root, valerian root, motherwort grass, dill fruits are used.
With intrahepatic cholestasis, tubes are performed (tubeless drainage of the biliary system, or "blind" probing) 1-2 times a week. Assign tonic drugs, choleretics and cholekinets. With increased activity of the liver enzyme ALT, choleretics are not prescribed.
With a hypokinetic type of biliary dyskinesia, sorbitol, xylitol, cholecystokinin, pancreozymin, magnesium sulfate, mineral waters of high salinity at room temperature or slightly warmed up 30-60 minutes before meals are recommended. Phytotherapy as in the hypotonic type.
With a hyperkinetic type of biliary dyskinesia, antispasmodics are used in a short course, potassium and magnesium preparations, mineral waters of weak mineralization in a heated form 5-6 times a day. Phytotherapy: chamomile flowers, peppermint, licorice root, valerian root, motherwort herb, dill fruit.

Therapy in each case is selected individually, and for this you need to contact a specialist. A comprehensive examination will be prescribed, and after making a diagnosis, the doctor will select the appropriate drugs. Self-medication is dangerous: incorrect recognition of symptoms can only lead to a deterioration in well-being.

Diet and proper nutrition

Nutrition is the cornerstone of treatment for dyskinesia. Only through strict observance of the rules, it is possible to avoid the occurrence of seizures and to prevent surgical complications such as cholelithiasis and acute cholecystitis. A diet for dyskinesia implies compliance with the general rules of nutrition, but there are points that differ significantly depending on the type of disease (hyperkinetic and hypokinetic).

The following foods should be completely excluded from the diet for any type of dyskinesia:

spicy, fried, fatty, smoked, sour, pickles and all canned;
fatty meats and fish;
confectionery, including chocolate, cocoa;
sweet pastry;
carbonated drinks, coffee, alcohol;
seasonings;
vegetables that irritate the digestive tract - garlic, onions, radishes, sorrel;
foods that increase gas formation in the intestines (legumes, rye bread, etc.);
milk;
marinades.

Features of nutrition in hypomotor dyskinesia. The diet should consist of products that stimulate the motility of the biliary tract:

cream;
eggs;
black bread;
sour cream;
vegetable and butter;
vegetables (boiled, stewed, baked);
fruit.

Features of nutrition in hypermotor dyskinesia:

In the presence of this form of pathology, it is imperative to exclude from the daily diet products that stimulate bile secretion and bile formation: soda, broths, fresh vegetables, fatty sour-milk and dairy products, black bread, animal fats.

With any form of dyskinesia, it is necessary to eat 5 to 6 times a day in small portions (the contents of a serving should fit in two handfuls). Do not allow breaks between meals for more than 2 hours. All meals and drinks should be warm or at room temperature, not cold or hot, because too high or low temperatures can trigger an attack of dyskinesia. Salt must be limited, consuming no more than 3 g per day to eliminate fluid stagnation in the tissues. Cooking various dishes should be done by boiling, baking or steaming.

Mineral water

Mineral water should be drunk regularly, 1/2 - 1 glass 20 - 30 minutes before meals in a warm form, choosing the required variety depending on the form of dyskinesia. So, with hypomotor dyskinesia, it is recommended to drink water of high mineralization (for example, Essentuki 17, Batalinskaya, Borjomi, Mashuk, etc.), and for hypermotor - low mineralization (for example, Darasun, Karachinskaya, Lipetskaya, Narzan, Smirnovskaya, etc.) .

You can and should drink mineral waters, as well as follow a diet, for a long period of time, that is, at least 3-4 months. However, if mineral waters cannot be included in the complex therapy of the disease, then their use can be completely abandoned.

Lifestyle with dyskinesia

For a patient with biliary dyskinesia, it is very important to lead a healthy lifestyle, which includes:

rejection of bad habits,
moderate physical activity, without physical overload,
rational mode of work and rest,
a full night's sleep

The main component of the lifestyle is a healthy diet - the exclusion of fatty, fried, spicy, salty, spicy foods, the restriction of animal products, and the increase in the consumption of plant products. During the period of treatment of dyskinesia, a strict diet, or treatment table No. 5, should be observed.

Folk remedies

At home, the treatment of dyskinesia is best done in combination with the use of folk methods. But before preparing and taking them, you should consult your doctor.

Infusions, decoctions, extracts and syrups of herbs are used that can activate the formation of bile, improve the motor function of sphincters and bile ducts.

In the hypertensive and hyperkinetic type, mint, chamomile flowers, motherwort herb, licorice root, dill fruits, valerian root are used.
In the hypotonic and hypokinetic form, rose hips, immortelle flowers, St. John's wort, corn stigmas, oregano, nettle leaves, and chamomile are used for herbal medicine.

Milk thistle, immortelle, tansy, dandelion leaves and root, corn stigmas, chicory, wild rose, fumes, parsley, turmeric root, cumin, yarrow have a choleretic effect.

Herbal decoctions are used 20-30 minutes before meals.

Surgery

In the absence of long-awaited relief after adequate and complex conservative therapy, doctors use surgical techniques. They may be:

minimally invasive (more often with the use of endoscopic equipment);
radical.

In case of revealed dysfunction of the sphincter of Oddi, the following is performed:

injections directly into this sphincter of botulinum toxin (it significantly reduces spasm and pressure, but the effect is temporary);
balloon dilatation of this sphincter;
setting a special caterer-stent into the bile duct;
endoscopic sphincterotomy (its excision together with the duodenal nipple) followed (if necessary) by surgical sphincteroplasty.

An extreme measure to combat severe hypotonic-hypokinetic variant of biliary dysfunction is cholecystectomy (complete removal of the atonic gallbladder). It is carried out laparoscopically (instead of an incision on the abdominal wall, several punctures are made for equipment and instruments) or laparotomy (with a traditional incision) by. But the effectiveness of this serious surgical intervention is not always felt by patients. Often after this, the resumption of complaints is associated with the developed postcholecystectomy syndrome. Rarely done.

Biliary dyskinesia in children

For therapy in children, preference is given to herbal preparations. They are selected depending on the type of pathology.

So, with hypomotor dyskinesia, the following are prescribed:

medicines that increase the tone of the biliary tract: magnesium sulfate, sorbitol or xylitol;
drugs that stimulate the formation of bile: cholagol, holosas, allochol, liobil;
"blind probing" with the intake of sorbitol or xylitol;
herbal therapy: decoctions of dandelion, wild rose, corn stigmas, mint;
mineral waters: "Essentuki 17".

With hypermotor dyskinesia, treatment is carried out:

herbal therapy: decoctions of St. John's wort, chamomile, nettle dioecious;
antispasmodic drugs: eufillin, riabal;
electrophoresis with novocaine on the gallbladder area;
low-mineralized waters: "Slavyanovskaya", "Smirnovskaya".

After stopping the attack, rehabilitation is carried out in a sanatorium, where mineral waters and other physiotherapy are prescribed:

sodium chloride baths;
microwave therapy;
galvanic collar according to Shcherbak;
with a sedative purpose: coniferous baths, bromelektroson;
to improve the motor activity of the biliary tract: SMT therapy, magnesium sulfate electrophoresis.
to eliminate spasm of the biliary tract: magnetotrapy, electrophoresis of antispasmodics (no-shpy, papaverine) on the area of the biliary tract /

Children with dyskinesia are registered with a pediatric gastroenerologist, neurologist and pediatrician. They are scheduled twice a year for a scheduled ultrasound. Also, once every 6 months, courses of choleretic therapy are carried out. Once or twice a year, the child is given referrals for sanatorium treatment.

Prevention

To prevent the appearance and development of pathology, you should:

Establish proper sleep and rest (sleep at least 8 hours a day);
Provide daily walks in the fresh air;
Organize a proper and balanced diet;
Eliminate the presence of stress and psycho-emotional stress.

In secondary prevention (that is, after the detection of dyskinesia), it is possible to prevent the disease by adhering to the doctor's recommendations and regularly undergoing preventive examinations

- This is a functional disease of the biliary system, which is based on a violation of the motility of the gallbladder and biliary tract, as well as the process of bile excretion. Pathology can develop according to the hyperkinetic or hypokinetic type; manifested by pain in the right hypochondrium, nausea, dyspepsia, neurosis-like symptoms. Diagnosis includes ultrasound of the biliary system, cholecystography, cholangiography, duodenal sounding, scintigraphy. Treatment is conservative: diet, taking choleretic drugs and antispasmodics, spa therapy, herbal medicine, hirudotherapy, physiotherapy.

General information

The basis of biliary dyskinesia is motor-tonic dysfunction of the gallbladder and sphincters of the bile ducts. This disrupts the emptying of the gallbladder and the flow of bile into the duodenum. Dyskinesia is the most common functional disorder of the hepatobiliary system and is the leading cause of cholestasis, as well as the formation of stones in the gallbladder and ducts. Pathology occurs predominantly in women. The most susceptible to the development of functional disorders of the biliary system are young people (from 20 to 40 years old) with an asthenic constitution and reduced nutrition.

Causes

According to the etiological mechanism, primary and secondary biliary dyskinesia are distinguished. Primary dysfunction is caused by a violation of the neurohumoral regulation of the activity of the hepatobiliary system due to neurosis, vegetative-vascular dysfunction and dietary errors. Secondary dyskinesia develops according to the mechanism of the viscero-visceral reflex against the background of other diseases of the digestive system.

According to the nature of the violation of the motor-tonic function of the gallbladder and sphincters, dyskinesias are distinguished, proceeding according to the hypertonic-hyperkinetic and hypotonic-hypokinetic type. Hypertonic-hyperkinetic (spastic) dyskinesia develops with increased tone of the parasympathetic autonomic nervous system; hypokinetic-hypotonic (atonic) - with the predominance of the tone of the sympathetic nervous system.

In both cases, as a result of the inconsistency of the work of the gallbladder and the sphincters of the bile ducts, the flow of bile into the lumen of the duodenum is disrupted, which leads to a breakdown in the digestive process. Depending on the type of dyskinesia (hyperkinetic or hypokinetic), various clinical manifestations develop.

Symptoms of dyskinesia

In the hypertensive-hyperkinetic variant of the pathology, the leading symptom is acute colicky pain in the right hypochondrium, radiating to the right shoulder blade and shoulder. A pain attack, as a rule, develops after an error in diet, excessive physical activity or psycho-emotional stress. The pain syndrome may be accompanied by nausea, sometimes vomiting, constipation or diarrhea, polyuria. The pain goes away on its own or is easily stopped by antispasmodics.

Outside of the attacks, the state of health is satisfactory, there are intermittent, short-term pain sensations of a spastic nature in the right hypochondrium, epigastrium, and paraumbilical region. Often, hypertensive dyskinesia is accompanied by vasomotor (tachycardia, hypotension, cardialgia) and neurovegetative (irritability, sweating, sleep disturbance, headaches) manifestations. Palpation of the abdomen during a painful attack reveals Kera's symptom - maximum pain in the projection of the gallbladder. The phenomena of intoxication and signs of the inflammatory process in the blood tests are absent.

Hypokinetic-hypotonic dyskinesia is characterized by constant, non-intense, dull, aching pain in the right hypochondrium, a feeling of heaviness and stretching in this area. Against the background of strong emotions and food intake, dyspeptic disorders develop - bitterness in the mouth, belching with air, nausea, loss of appetite, flatulence, constipation or diarrhea. Palpation of the abdomen reveals moderate pain in the projection of the gallbladder, a positive symptom of Ortner. Neurosis-like manifestations are noted: tearfulness, irritability, mood swings, increased fatigue.

Diagnostics

The task of diagnosis is to verify the disease, determine the type of biliary dyskinesia, exclude concomitant diseases that support dysfunction. Ultrasound of the gallbladder and biliary tract is aimed at determining the shape, size, deformation, congenital anomalies, stones of the biliary system. To determine the type of dyskinesia, ultrasound is performed on an empty stomach and after taking a choleretic breakfast, which allows assessing the contractile function of the gallbladder.

An informative diagnostic method is fractional duodenal sounding with the study of duodenal contents. By probing the duodenum, the tone, motility, reactivity, and the state of the sphincter apparatus of the extrahepatic bile ducts are determined. With hyperkinetic dyskinesia of the biliary tract, the level of the lipoprotein complex and cholesterol in portion B decreases; with hypokinetic - increases.

X-ray examination includes cholecystography and cholangiography. With their help, the architectonics and motility of the biliary tract are assessed. In a comprehensive examination, sphincter of Oddi manometry, cholescintigraphy, MRI of the liver and biliary tract can be used. It is advisable to study the coprogram, feces for dysbacteriosis and helminth eggs.

Treatment of biliary dyskinesia

Restoration of the function of bile formation and bile excretion in different types of dyskinesia is also carried out differentially. With hyperkinesia, choleretics (dry bile, cattle pancreas extract, flamin, hydroxymethylnicotinamide, oxafenamide), weakly mineralized mineral waters in a heated form, antispasmodics (drotaverine, papaverine, platyfillin), phytocollections (decoctions of chamomile, peppermint, licorice root, dill fruits) .

Of the non-drug methods for patients with hypertensive-hyperkinetic biliary dyskinesia, courses of psychotherapy, acupuncture, hirudotherapy, applications of ozocerite and paraffin, diathermy, inductothermy, microwave therapy, electrophoresis with antispasmodics, acupressure, massage of the collar zone are recommended.

In the hypotonic variant, cholekinetics (xylitol, magnesium sulfate, sorbitol), highly mineralized waters at room temperature, herbal medicine (decoctions of immortelle flowers, nettle leaves, rose hips, oregano, St. John's wort) are prescribed. With signs of intrahepatic cholestasis, a "blind" probing (tubage) is indicated. To increase the general tone, exercise therapy is prescribed, stimulating water procedures, tonic massage.

Of the methods of physiotherapy, diadynamic therapy, electrophoresis with magnesium sulfate on the liver area, low-intensity ultrasound, SMT therapy, and low-frequency pulsed currents are used. Patients with biliary dyskinesia are shown to be monitored by a gastroenterologist and a neurologist, annual health courses in balneological sanatoriums.

Forecast and prevention

The course of the pathology is chronic, however, with a diet, a healthy lifestyle, timely and proper treatment, the disease can proceed without exacerbations. Otherwise, it is possible to develop complications from the hepetobiliary system - calculous cholecystitis and cholangitis. Prevention of primary dyskinesia requires adherence to the principles of healthy eating, timely correction of disorders of the psycho-emotional sphere; prevention of secondary dyskinesia - elimination of the underlying disease.

Functional disorders of the tone and motility of the gallbladder, bile ducts and their sphincters, manifested by a violation of the outflow of bile into the duodenum, accompanied by the appearance of pain in the right hypochondrium. At the same time, there are no organic changes in these organs.

Medical practice indicates that women are more susceptible to the occurrence of dyskinesias. There is evidence that biliary dyskinesia in women occurs 10 times more often than in men. It is noted that the incidence of hyperkinetic dyskinesia is more often observed in young people, and hypokinetic dyskinesia is typical for those who are already forty years old, and it also develops in people who suffer from mental instability.

gallbladder dysfunction

gallbladder dysfunction- this is a violation of the contractility of the gallbladder, which is accompanied by pain such as biliary colic and is often combined with a violation of the emptying of the gallbladder. Gallbladder dyskinesia does not pose a threat to life, but significantly reduces comfort. In addition, it creates the conditions for the development of more serious disorders. For example, with prolonged dyskinesia, gallstone disease and other diseases of the gastrointestinal tract can develop.

Sphincter of Oddi dysfunction

Sphincter of Oddi dysfunction- this is a violation of its contractility Sphincter of Oddi, regulates the portioned flow of bile and pancreatic juice into the duodenum. Dysfunction of the sphincter of Oddi can be a primary, but more often a secondary disease, can accompany peptic ulcer, cholecystitis, cholelithiasis, postcholecystectomy syndrome, and more.

Types of biliary dyskinesia

Biliary dyskinesia with inadequate supply of bile is called hypokinesia;
with excess bile hyperkinesia bile ducts.

Causes of biliary dyskinesia

The causes of biliary dyskinesia in each case are ambiguous. But, as a rule, a person "earns on his own", thanks to his eating habits, which are formed in childhood, in adolescence.

Almost always, dyskinesia is diagnosed as a secondary disease. It manifests itself in humans as a consequence of some factors leading to disruption of the biliary tract.

With hypermotor dyskinesia, a person feels cramping, sometimes very sharp pains in the right hypochondrium, bitterness in the mouth, upset stool. With hypomotor dyskinesia - pulling pains, heaviness in the right hypochondrium, nausea, constipation. As a rule, these unpleasant sensations appear after eating, but can also be associated directly with eating.

So, the disease occurs in people who have suffered at one time acute viral hepatitis, neurocirculatory dysfunction.

Biliary dyskinesia in children and adults is considered as a psychosomatic disease that can be provoked by mental trauma, as well as severe stress.

It has been proven that the motor activity of the gallbladder directly depends on stress and strong negative emotions: in this case, it slows down significantly, and stagnation of bile occurs in the gallbladder.

Very often, when studying the case histories of such patients, it turns out that they had psychological problems of a diverse nature at one time.

In addition, the trigger for the development of dyskinesia of the gallbladder can be impaired nervous regulation of the gallbladder, menopause, and insufficiency of the function of the endocrine glands.

There is also the possibility of joining dyskinesia to cholelithiasis, cholecystitis. In patients with peptic ulcer, appendicitis, a reflex occurrence of hyperkinetic dyskinesia occurs. This form of the disease also threatens those who eat irregularly, too often eat very spicy foods that irritate the mucous membrane.

If we are talking about hypertensive dyskinesia, then such pain is distinguished by a paroxysmal character. In this case, the pain is quite acute, but lasts a short period of time. Pain may radiate to the right shoulder or shoulder blade. Especially often such attacks occur after eating fatty foods, strong stress, both physical and emotional. Very often, patients with hypertensive dyskinesia note a manifestation of bitterness in the mouth, which most often happens in the morning.

In addition, symptoms of biliary dyskinesia in men may include a decrease in sexual activity. At the same time, menstruation may be disrupted in women.

Common signs of dyskinesia are depression, emotional as well as physical weakness. During an attack of biliary colic, the patient may experience a feeling of a strong heartbeat or a feeling of cardiac arrest. He may be accompanied by a feeling of fear, numbness of the limbs.

Over time, dyskinesia can cause inflammation in the gallbladder and ducts, and cause gallstones to form.

Treatment of biliary dyskinesia

Treatment is complex and includes:

From the very first days of treatment, the state of the autonomic nervous system is corrected. With hypertensive and hyperkinetic type of biliary dyskinesia, sedatives are prescribed: bromides, infusion of valerian, motherwort.

With hypotonic and hypokinetic type of biliary dyskinesia, tonic preparations are used: extract of eleutherococcus, leuzea, tincture of ginseng, aralia, magnolia vine.

Antibacterial therapy for this pathology is not indicated. When prescribing chemotherapy drugs for another concomitant disease, it is necessary to take into account the possible adverse effect of these drugs on the function of the biliary system.

When giardiasis or other helminthic invasion is detected, anthelmintic therapy is mandatory.

A special role belongs to choleretic agents. According to their mechanism of action, they are divided into:

choleretics(increase the formation of bile);
cholekinetics(contribute to the release of bile from the bladder into the intestinal lumen).

Choleretics include:

allochol, cholenzym, cholecin, lyobil and other drugs with bile acids;
nikodin, oxafenamide, tsikvalon (synthetic preparations);
immortelle, corn stigmas, tansy, wild rose, cholagol, olimetin (herbal preparations);
valerian preparations, mineral water (increased bile secretion due to the water component).

Cholekinetics include:

magnesium sulfate, sorbitol, xylitol, berberine bisulfate (increase the tone of the gallbladder and reduce the tone of the biliary tract);
antispasmodics, eufillin (relaxes the sphincters of the biliary system).

The choice of drugs to restore the functions of bile formation and bile secretion depends on the type of dyskinesia.

With hypertensive type of biliary dyskinesia apply oxafenamide, nikodin, mineral waters of low mineralization (Slavyanovskaya, Smirnovskaya, Essentuki 4, 20, Narzan in hot or heated form 5-6 times a day). For herbal medicine, chamomile flowers, peppermint, licorice root, valerian root, motherwort grass, dill fruits are used.

With hypotonic type of biliary dyskinesia prescribe flamin, cholecystokinin, magnesium sulfate, pancreozymin; mineral waters of high mineralization (Essentuki 17, Arzni and others, at room temperature or slightly warmed up 30-60 minutes before meals, depending on the secretion of the stomach). Phytotherapy: corn stigmas, immortelle flowers, chamomile, nettle leaves, rose hips, St. John's wort, oregano.

With hyperkinetic type of biliary dyskinesia use antispasmodics in a short course, potassium and magnesium preparations, mineral waters of weak mineralization in a heated form 5-6 times a day. Phytotherapy: chamomile flowers, peppermint, licorice root, valerian root, motherwort herb, dill fruit.

With hypokinetic type of biliary dyskinesia recommend sorbitol, xylitol, cholecystokinin, pancreozymin, magnesium sulfate, mineral waters of high salinity at room temperature or slightly warmed up 30-60 minutes before meals. Phytotherapy as in the hypotonic type.

With intrahepatic cholestasis Tubage is carried out (tubeless drainage of the biliary system, or "blind" probing) 1-2 times a week. Assign tonic drugs, choleretics and cholekinets. With increased activity of the liver enzyme ALT, choleretics are not prescribed.

Treatment of children with biliary dyskinesia

Treatment of children with biliary dyskinesia is carried out until the complete elimination of bile stasis and signs of impaired bile flow. With severe pain, it is advisable to treat the child in a hospital for 10-14 days, and then in a local sanatorium.

Timely diagnosis of biliary tract dysfunctions and proper treatment of children, depending on the type of violations detected, can prevent the formation of inflammatory diseases of the gallbladder, liver, pancreas in the future and prevents early stone formation in the gallbladder and kidneys.

Complications of biliary dyskinesia

Over time, an inflammatory process or gallstone disease can occur in the gallbladder and ducts.

Biliary dyskinesia is a functional disorder of the flow of bile into the duodenum. The condition is considered a harbinger or "accomplice" of other more complex diseases of the digestive system. Therefore, timely treatment of biliary dyskinesia requires separate consideration and careful attention.

Basic principles of treatment

There are many tips for the treatment of dyskinesia. We will make a plan of action for ourselves and we will follow it. What do we have to do to cure dyskinesia?

Normalize emotional stress, help the nervous system to endure stressful conditions, overwork.
Provide a diet and diet during an exacerbation of the disease.
Control weight and exercise.
Build a choice of medicines depending on the type of dyskinesia.
Use mineral waters according to indications.
Medicinal plants and traditional medicine are no less important than drugs.

What to do with "abnormal" emotions?

It is known that the nervous system is the source of all "commands" and "control decisions". With biliary dyskinesia, one of the good reasons is the breakdown of nervous regulation. To normalize, you need to calm down by any means (except alcohol!). It is suitable to take a decoction of valerian root or tincture, preparations from motherwort, and other sedatives as prescribed by a doctor. The usual home treatments: a warm bath in the evening, milk with honey at night, may normalize sleep, help cure dyskinesia.

You will have to get rid of excessive nervous load. The daily routine should include time for rest, walks. You can do yoga, swimming, cycling.

This will also help to reduce excess weight, if any. Because excess weight raises the level of the diaphragm and puts pressure on the gallbladder from below, preventing it from contracting effectively. In addition, excess calories in fatty foods create an unbearable burden on the liver and disrupt the work of the biliary tract.

Dietary changes

You will have to eat without sandwiches, fast food, chips, shawarma and kebabs. The diet recommends table number 5 with the restriction of spicy dishes, fried and fatty meat and fish, sauces and seasonings, sausages, mayonnaise, cakes, strong coffee.

Shown: boiled or steamed, low-fat meat and fish dishes, cereals (rice and semolina are not recommended), dairy products, vegetable salads with vegetable oil dressing, fruits.

It is impossible to cure dyskinesia without a diet. The restoration of bile secretion depends on the organization of nutrition in small portions several times a day.

Medication use

Do not use medicines on the advice of neighbors. They will not be able to establish your type of dyskinesia, choose a medicine that matches the condition of other organs. Only a doctor can treat.

For hypertonic type apply:

as sedatives (Motherwort-forte in capsules, Motherwort and Valerian in tincture, tablets with a sedative effect);
to relieve pain, antispasmodics (injections of Platifillin, No-shpa, Papaverine or tablets in the interictal period);
from the group of choleretic drugs, drugs that promote the promotion of bile (Oxafenamide, Nicodin);

With a hypotonic type, the body needs a different effect:

to activate nervous processes (tinctures of Ginseng, Eleutherococcus, Levzei, Schisandra chinensis, Aralia);
choleretic agents stimulating muscle atony (Cholecystokinin, Flamin);
recommended tubage or "blind probing" twice a week for two months every six months, for this use magnesia, xylitol, sorbitol.

It is necessary to treat biliary dyskinesia with antibacterial drugs only if an infectious cause is established during duodenal sounding.

Mineral water

Reception of therapeutic mineral waters must be coordinated with the acidity of gastric juice and also the type of biliary dyskinesia:

with hypertonic dyskinesia, normal or high acidity, mineral waters such as Narzan, Essentuki-4, Smirnovskaya, Slavyanovskaya are recommended in a warm state one hour - 40 minutes before meals;
for the hypotonic type, low acidity, you need to drink Essentuki-17, Arzni (they are more mineralized) at room temperature half an hour before meals, carefully in the presence of kidney diseases.

Treatment of dyskinesia with herbs

The benefits of herbal treatment have long been known: they have been tested for centuries by traditional medicine, they are easy to prepare, and side effects are minimal. It is necessary to take herbs for biliary dyskinesia only after consulting with a good specialist.

For the hypertensive type, decoctions are recommended in treatment: chamomile, valerian, mint, licorice root, dill seeds.
A person with a hypotonic type is shown: chamomile, immortelle, wild rose, corn stigmas, nettle.

It is most convenient to brew herbs overnight in a liter thermos in proportion to 3 tablespoons of dry raw materials per liter of boiling water. In the morning you can drink warm, pouring into a cup through a strainer. You can use each plant individually or mix in advance. Such a collection will be much more efficient. The brewed volume is enough for the whole day. Take herbal decoctions 30-40 minutes before meals.
The main contraindication: increased individual sensitivity.

The main task of treating biliary dyskinesia is to prevent the development of chronic cholecystitis, cholelithiasis. This can be done with firm determination and perseverance.