Gallbladder • Patient Education
Biliary Dyskinesia: Gallbladder Pain Without Gallstones
Some people have classic gallbladder attacks, pain in the upper right belly after meals, sometimes spreading to the back or shoulder, yet their ultrasound shows no gallstones. One possible explanation is biliary dyskinesia, a condition in which the gallbladder does not empty properly. It is less common and harder to diagnose than gallstones, and treatment decisions need care.
By the surgical team at Surgical Associates of Southern Texas · Updated September 30, 2026
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Gallbladder pain but a normal ultrasound?
Dr. Murtaza Shakir can review your tests and discuss whether biliary dyskinesia fits your symptoms. Call now, or send us your details and our team will call you back.
THE SHORT ANSWER
Biliary dyskinesia is a functional gallbladder disorder: typical gallbladder-type pain without gallstones, usually with poor gallbladder emptying on a nuclear medicine test called a HIDA scan with cholecystokinin (CCK). After other causes of upper abdominal pain are ruled out, some patients benefit from gallbladder removal, but results are less predictable than surgery for gallstones, so careful evaluation matters.
What Is Biliary Dyskinesia?
The gallbladder stores bile and squeezes it into the intestine after you eat, especially after fatty foods. In biliary dyskinesia, the gallbladder muscle does not contract normally. The result can be recurring episodes of pain that feel just like a gallstone attack, even though no stones are present. Doctors also call it functional gallbladder disorder.
What Are the Symptoms?
- Episodes of steady pain in the upper right or upper middle abdomen, often lasting 30 minutes or longer
- Pain that may spread to the back or right shoulder blade
- Nausea, and sometimes vomiting, during episodes
- Episodes that recur and interfere with daily life
Constant burning pain, pain relieved by antacids, or symptoms that change with bowel movements point more toward other conditions such as reflux, ulcers or irritable bowel syndrome.
How Is Biliary Dyskinesia Diagnosed?
Diagnosis is largely a process of elimination. Evaluation commonly includes:
- An abdominal ultrasound to confirm there are no gallstones or sludge
- Blood tests, including liver tests and lipase
- An upper endoscopy in some patients, to look for ulcers or inflammation
- A HIDA scan with CCK, which measures how much of its contents the gallbladder empties, reported as the gallbladder ejection fraction
A low ejection fraction together with typical symptoms and no other explanation supports the diagnosis. A low number alone, without typical pain, is not enough.
Gallbladder Pain but a Normal Ultrasound?
Dr. Murtaza Shakir can review your tests and discuss whether biliary dyskinesia fits your symptoms.
Is Surgery the Treatment?
For carefully selected patients, laparoscopic gallbladder removal can relieve symptoms. Selection matters because not everyone with a low ejection fraction improves after surgery. Surgeons look for typical, recurrent biliary-type pain, a thorough search for other causes, and symptoms that meaningfully affect quality of life. Learn about laparoscopic gallbladder removal.
When Should I See a General Surgeon?
If you have repeated gallbladder-type attacks and your ultrasound was normal, a general surgeon can review your testing, recommend whether a HIDA scan is appropriate, and help decide whether surgery is likely to help. Bring your ultrasound, blood work, and any endoscopy or HIDA results to the visit.
Frequently Asked Questions
Can you have gallbladder problems without gallstones?
Yes. Biliary dyskinesia, gallbladder sludge, polyps and acalculous cholecystitis are gallbladder problems that can occur without stones.
What is a normal gallbladder ejection fraction?
Laboratories set their own reference ranges, and many consider an ejection fraction below about 35 to 40 percent to be low. The result must be interpreted together with symptoms.
Will removing my gallbladder cure the pain?
Many carefully selected patients improve, but relief is less certain than after surgery for gallstones. That is why ruling out other causes first is important.
Is biliary dyskinesia dangerous?
It is not usually dangerous in the way that infected gallbladders or blocked bile ducts can be, but it can be painful and disruptive. New fever, jaundice or severe pain still needs urgent care.
Key Takeaway
Gallbladder-type pain without gallstones may be biliary dyskinesia. Diagnosis relies on typical symptoms, a normal ultrasound, a HIDA scan showing poor emptying, and ruling out other causes; gallbladder removal helps many, but not all, carefully selected patients.
Sources and Further Reading
- Gallbladder Diseases, MedlinePlus
- Cholecystokinin Test, StatPearls (NCBI Bookshelf)
- Laparoscopic Cholecystectomy, StatPearls (NCBI Bookshelf)
This article is general education, not personal medical advice. For severe abdominal pain, fever with abdominal pain, or yellowing of the skin or eyes, seek emergency care.
Meet the Surgeon
Dr. Murtaza Shakir is a board-certified General Surgeon and is board certified in Complex General Surgical Oncology. He earned his medical degree at Aga Khan University, completed General Surgery residency at Riverside Methodist Hospital in Columbus, Ohio, and a two-year Surgical Oncology fellowship at the University of Pittsburgh Medical Center. He sees patients at Surgical Associates of Southern Texas in Katy and Sugar Land.
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This page provides general information and is not a substitute for medical advice. For severe abdominal pain or other emergencies, call 911 or go to the nearest emergency room. Last updated September 30, 2026.