Biliary Disease

Biliary disease is a general term for various conditions that affect your biliary system. This system includes organs like your liver, gallbladder and bile ducts. It transports bile for digestion, helps your body digest fats and removes waste.

Biliary disease happens when the normal flow of bile is blocked or disrupted. When bile can’t flow properly, it can build up and lead to symptoms like abdominal pain, jaundice and itching. Some of the most common causes are gallstones, inflammation and autoimmune issues.

You may hear biliary disease referred to as “biliary system disease,” “biliary tract disease” or “bile duct disease.” All of these terms could mean a wide range of conditions. Some are mild and may not cause symptoms. But others can become serious without treatment.

Types of biliary disease

Common biliary system diseases include:

• Gallstones: Gallstones are hardened pieces of bile that form in your gallbladder. They may not cause symptoms unless they block bile flow.
• Biliary colic: Biliary colic is pain caused by the temporary blockage of a bile duct, usually from gallstones. The pain often comes and goes.
• Cholecystitis: Cholecystitis is inflammation of your gallbladder, most often caused by gallstones blocking bile flow. It can lead to pain, swelling and infection.
• Cholangitis: Cholangitis is an infection of your bile ducts that occurs when bile flow is blocked. It can become serious without prompt treatment.
• Gallstone pancreatitis: This condition happens when a gallstone blocks a bile duct near your pancreas and causes inflammation. Symptoms can range from mild to severe.
• Biliary dyskinesia: Biliary dyskinesia occurs when your gallbladder doesn’t empty bile properly. It can cause symptoms even if you don’t have gallstones.

Rare types of biliary disease include:

• Sphincter of Oddi dysfunction: This condition affects the muscle that controls bile flow into your small intestine. When the muscle doesn’t relax normally, bile can back up and cause pain.
• Bile duct strictures: Strictures are areas where your bile ducts become narrowed due to scarring or injury. This narrowing can slow or block bile flow.
• Primary biliary cholangitis (PBC): PBC is a long-term (chronic) disease that damages small bile ducts in your liver over time. This damage causes bile to build up in your liver.
• Primary sclerosing cholangitis (PSC): PSC causes inflammation and scarring of the bile ducts inside and outside your liver. Over time, it can block bile flow and damage your liver.
• Biliary atresia: Biliary atresia is a rare condition present at birth where your bile ducts don’t form correctly. It prevents bile from leaving your liver and requires early treatment.
• Bile duct cancer: This is a rare cancer that starts in your bile ducts. It can block bile flow and is often found at a later stage.

Biliary duct disease symptoms

Biliary disease symptoms can start suddenly or develop slowly over time. They often happen when bile can’t flow normally. Symptoms may include:

• Severe upper right abdominal pain
• Fever and chills
• Nausea and vomiting
• Jaundice (yellowing of your skin and the whites of your eyes)
• Itchy skin
• Extreme tiredness (fatigue) or low energy
• Clay-colored poop and dark pee
• Loss of appetite
• Unintended weight loss

Biliary tract disease causes

Biliary disease develops when something interferes with the normal flow of bile. This can happen if your bile ducts become blocked, inflamed, narrowed or damaged. Problems may develop suddenly or over time. These problems can affect your gallbladder, bile ducts, liver or nearby organs. When bile can’t move properly, it can build up and lead to symptoms and complications.

Risk factors

Your risk of developing biliary disease tends to rise with age. That’s because conditions like gallstones more often affect people over 40. Other factors that can increase your risk include:

• Having a biological family history of biliary disease
• Having overweight or obesity
• Experiencing rapid weight loss
• Having high cholesterol
• Being pregnant
• Having an autoimmune condition

Complications of this condition

Without treatment, complications from biliary disease can occur. These include:

• Ongoing gallbladder or bile duct inflammation or infection
• Liver damage
• Poor digestion of fats and vitamins
• Cirrhosis (liver scarring)
• Liver failure

How doctors diagnose biliary tract disease

Your healthcare provider will ask you about your symptoms and medical history, and they’ll perform a physical exam. They’ll look for signs that bile isn’t flowing normally, like jaundice or abdominal pain.

Your provider will also order certain tests, including:

• Blood tests: Blood tests can show signs of a bile duct blockage or liver stress.
• Imaging tests: Depending on the suspected cause, these tests may include ultrasound, CT scan or MRI.
• Specialized bile duct tests: These are procedures that let your provider view your bile ducts directly, collect samples or treat a blockage.

How is biliary disease treated?

Biliary disease treatment depends on the cause, severity and whether the condition is urgent or ongoing. The goals are to relieve any blockages, manage inflammation and prevent damage.

For milder cases, your healthcare provider may start with noninvasive methods, like:

• Monitoring: If your symptoms are mild, they may recommend “watchful waiting” with regular follow-ups.
• Lifestyle changes: Your provider may suggest eating foods that contain less fat. This can help reduce symptoms and support bile flow.
• Medications: Certain medicines can help reduce inflammation or treat infections. Other medications may relieve symptoms like itching and nausea.
• IV fluids and rest: During flare-ups or inflammation, you may need fluids and bowel rest to allow your digestive system to recover.

If bile flow is blocked, your symptoms are severe or complications develop, your provider may recommend surgical procedures, like:

• Endoscopic procedures: Your provider will use a specialized scope to find and remove gallstones, widen narrowed bile ducts or improve bile flow.
• Gallbladder removal: If you have ongoing symptoms or repeatedly get gallstones, your provider may recommend removing your gallbladder.
• Bile duct repair or stenting: If your bile ducts are narrowed or damaged, your provider may widen or support them with a small tube to keep bile flowing.
• Liver transplant: If biliary disease leads to liver failure, you may need a transplant.

When should I see my healthcare provider?

Get medical care right away if you have:

• Yellowing of your skin or the whites of your eyes (jaundice)
• Fever or chills along with abdominal pain
• Severe or worsening belly pain
• Chest pain that feels unusual or intense

Early care can help prevent serious complications and guide the right treatment.

What is the outlook (prognosis) for biliary disease?

The outlook for biliary system disease depends on the cause and how quickly you get treatment. Your provider can treat many biliary conditions successfully, especially those caused by gallstones.

When biliary disease is found early, most people recover well and return to normal activities. Chronic or rare bile duct diseases may require long-term care and monitoring. If left untreated, some conditions can lead to serious complications, including liver damage. But early treatment greatly improves outcomes.

Can biliary disease be prevented?

You can’t prevent all biliary disease conditions, but there are some ways to help lower your risk. Steps you can take include:

• Maintaining a healthy weight for you
• Avoiding rapid weight loss
• Eating nutritious, healthy meals
• Staying physically active
• Managing conditions like high cholesterol and diabetes
• Seeing your healthcare provider regularly