Bile is a greenish-yellow digestive fluid that is produced in the liver and is stored in the gallbladder. It helps in the digestion of fats, elimination of worn-out red blood cells and toxins from the body. Bile reflux occurs when bile backs up or refluxes into the stomach. It is accompanied by acid reflux, which is the reflux of stomach acids into the esophagus.
Bile reflux and acid reflux are different medical conditions. Acid reflux may be caused when the patients do not respond properly to powerful acid-suppressant medications. Bile reflux cannot be completely controlled by changes in diet or lifestyle. Treatment is required.
Bile juice gets mixed with food in the duodenum and enters the small intestine through the pyloric valve. The pyloric valve usually opens slightly to allow liquefied food into the stomach. In the case of bile reflux, the valve does not close properly, and bile washes back into the stomach. This occurs when the lower esophageal sphincter (which separates the esophagus and stomach) malfunctions. The weakened valve leads to the backwash of bile into the esophagus.
Bile reflux can lead to complications such as GERD, Barrett’s esophagus, and esophageal cancer.
The causes of bile reflux include, but are not limited to:
Surgery Complications: Gastrectomy and gastric bypass surgery are the most common causes of bile reflux.
Peptic Ulcers: A peptic ulcer blocks the pyloric valve, not allowing the stomach to empty up. Stagnant food in the stomach leads to increased gastric pressure. Thereby, bile backs up into the esophagus.
Cholecystectomy: Patients who had a cholecystectomy (removal of the gallbladder) are more susceptible to bile refluxes.
You may experience certain signs and symptoms due to bile reflux, which includes:
Your doctor would order certain diagnostic tests to confirm the bile reflux which includes:
Endoscopy: Endoscopic study reveals the presence of peptic ulcers or any inflammation in the stomach and esophagus. This procedure is performed using an endoscope (camera), a thin and flexible tube, if required tissue samples can also be collected by endoscopic study for testing Barrett’s esophagus or esophageal cancer.
Esophageal Impedance:
Esophageal impedance is performed to identify whether the gas or liquids reflux into the esophagus. This procedure is performed by using a catheter and a probe that is placed into the esophagus.
Ambulatory Acid Tests: Ambulatory acid tests are performed to identify the frequency and duration of refluxes that occur in your esophagus. These tests are also helpful to rule out acid refluxes. The tests are performed by using a catheter and a probe.
Lifestyle modifications may not be effective for treating bile reflux. Therefore, a prompt medical treatment would be recommended for treating the bile reflux. Your doctor will prescribe appropriate medications which include:
Ursodeoxycholic Acid: It helps to promote bile flow. It also decreases the frequency and severity of the symptoms.
Bile Acid Sequestrants: These disrupt the bile circulation but may pose side effects such as bloating.
Proton Pump Inhibitors: These medications block acid production.
If the bile reflux does not subside with medications, your doctor would recommend surgical options, which include:
Anti-Reflux Surgery (fundoplication): In this procedure, the fundus is wrapped and sewed around the lower esophageal sphincter to strengthen the valve and reduce acid reflux. Diversion Surgery: It is a weight-loss surgery that is recommended for patients who have had previous gastric surgery with pylorus removal. In this procedure, a new connection is made for the drainage of bile further lower in the small intestine, diverting the bile juice away from the stomach.
Bile reflux and acid reflux are different medical conditions. Acid reflux may be caused when the patients do not respond properly to powerful acid-suppressant medications. Bile reflux cannot be completely controlled by changes in diet or lifestyle. Treatment is required.
Bile reflux can lead to complications such as GERD, Barrett’s esophagus, and esophageal cancer.
Signs and symptoms due to bile reflux includes Cough, Nausea, Vomiting, Hoarseness, Frequent heartburn, Unintentional weight loss, Pain in the upper abdominal area.
