Maya from Houston sent us this question:
“I am a 45-year-old woman in overall good health. I am overweight but not obese and I live a very active lifestyle. After many years of regular bouts of intense acid reflux (started in my 20s when I was thinner than I am now) my doctor put me on a daily dose 20mg of Omeprazole when I was pregnant with my second child. It was a game changer allowing me to eat/drink almost anything with no discomfort.
After 5 years on it, I woke up one day in excruciating pain ultimately going to the ER unsure of what was happening. Looking at my symptoms and location of pain (upper right quadrant) there was thought that it was my gallbladder, but no stones were detected, and I was sent on my way.
I went to my gastroenterologist, and they ordered a HIDA scan which showed that I had a very low functioning gallbladder, and they diagnosed me with biliary dyskinesia and recommended I surgically remove my gallbladder.
I did not act on this right away and ended up in the ER again in excruciating pain about 10 months later. The pain subsided after a few hours, and I was sent home. No treatment or next steps.
I had an upper endoscopy, and they were able to see that I have a very small hiatal hernia, but they felt that it was so small it wasn’t worth operating on. They did say that I should still plan to get my gallbladder removed but they also said that it was no guarantee I would not still get these painful attacks.
It’s been 9 months now since my last attack. I currently take 40mg of Omeprazole per doctor’s prescription.
I am very conflicted about scheduling the surgery, is it necessary? Is the Omeprazole the reason for my low functioning gallbladder? Will my acid reflux be even worse after removal? Should I explore the hernia again and see if surgery makes sense for that? I just don’t know which thing to tackle first. Thank you.”
Dear Maya,
Biliary dyskinesia (often described as a “sluggish” or “lazy” gallbladder) and gastroesophageal reflux disease (GERD) can produce overlapping symptoms, including pain beneath the breastbone, nausea, bloating, and digestive discomfort. Because of this overlap, distinguishing between the two conditions can be challenging—but it is certainly possible with careful clinical evaluation.
In your case, there is clear evidence of longstanding GERD. Pregnancy is known to worsen reflux symptoms, and during your second pregnancy you were appropriately started on proton pump inhibitor (PPI) therapy to control acid reflux. Your positive response to PPIs further supports the diagnosis of GERD.
Approximately five years later, you developed sudden right upper abdominal pain, a symptom more typically associated with gallbladder disease. You also had several well-known risk factors for gallbladder dysfunction, including female sex, a history of multiple pregnancies, increasing age, and being overweight.
There is some evidence suggesting that chronic PPI use may reduce gallbladder ejection fraction and potentially contribute to biliary dyskinesia or gallstone formation. While the exact mechanism is not fully understood and the association is not definitively established, this raises the reasonable consideration of discontinuing PPIs to assess whether gallbladder function improves.
In your situation, however, your PPI dose was increased to adequately control reflux symptoms, underscoring the severity and persistence of your GERD. Additionally, the finding of a small hiatal hernia on endoscopy does not rule out significant GERD and does not exclude you from being a candidate for anti-reflux surgery.
In my opinion, it is important to complete your GERD evaluation with esophageal manometry and ambulatory pH testing.
Esophageal manometry assesses how well the lower esophageal sphincter (LES) functions, while pH testing measures the amount of acid exposure in the esophagus over time. Together, these studies confirm the diagnosis of GERD and help determine its severity.
If testing confirms significant acid reflux, hiatal hernia repair with Nissen fundoplication is recommended to restore the natural anti-reflux barrier and reliably control reflux. When properly performed, this operation has a very high success rate and often allows patients to discontinue proton pump inhibitors (PPIs).
During anti-reflux surgery, gallbladder removal can be performed safely at the same time if needed. However, in your case, there is a reasonable option to first monitor your biliary dyskinesia–related symptoms after anti-reflux surgery, especially once you are off PPIs.
If your right-sided abdominal pain resolves after surgery and stopping acid-suppressing medications, gallbladder surgery may not be necessary. In this situation, chronic PPI use and prolonged acid suppression may have contributed to biliary symptoms.
If, however, abdominal pain persists or recurs, a second, separate operation to remove the gallbladder would then be appropriate.