What is bile reflux?
Bile reflux occurs when bile — a digestive liquid produced in your liver — backs up (refluxes) into your stomach and the tube that connects your mouth and stomach (esophagus).
Bile reflux may accompany acid reflux, the medical term for the backwash of stomach acids into your esophagus. However, bile acid reflux and acid reflux are separate conditions.
Whether bile is important in reflux is controversial. Bile is often a suspected cause of reflux when people respond incompletely or not at all to powerful acid-suppressant medications. But there is little evidence pinpointing the effects of bile reflux in people.
Unlike acid reflux, bile reflux usually can’t be completely controlled by changes in diet or lifestyle. Treatment involves medications or, in severe cases, surgery.
How common is bile reflux?
Bile reflux is very infrequent in healthy individuals. Bile reflux is common in individuals who have had surgery to remove their gallbladder or those who have undergone gastric surgery, including a total or partial removal of the stomach (gastrectomy) or gastric bypass surgery for weight loss. It also is common in patients with peptic ulcers. Please discuss with your doctor for further information.
What are the symptoms of bile reflux?
The common symptoms of bile reflux are:
- Upper abdominal pain that may be severe
- Frequent heartburn — a burning sensation in your chest that sometimes spreads to your throat, along with a sour taste in your mouth
- Vomiting a greenish-yellow fluid (bile)
- Occasionally, a cough or hoarseness
- Unintended weight loss
Bile reflux can be difficult to distinguish from acid reflux. The signs and symptoms are similar, and the two conditions may occur at the same time. It isn’t clear what role bile plays in reflux conditions
There may be some symptoms not listed above. If you have any concerns about a symptom, please consult your doctor.
When should I see my doctor?
If you have any signs or symptoms listed above or have any questions, please consult with your doctor. Everyone’s body acts differently. It is always best to discuss with your doctor what is best for your situation.
What causes bile reflux?
Bile is a greenish-yellow fluid that is essential for digesting fats and for eliminating worn-out red blood cells and certain toxins from your body. Bile is produced in your liver and stored in your gallbladder.
Eating a meal that contains even a small amount of fat signals your gallbladder to release bile, which flows through two small tubes (cystic duct and common bile duct) into the upper part of your small intestine (duodenum).
Bile reflux into the stomach
Bile and food mix in the duodenum and enter your small intestine through the pyloric valve, a heavy ring of muscle located at the outlet of your stomach. The pyloric valve usually opens only slightly — enough to release about an eighth of an ounce (about 3.5 milliliters) of liquefied food at a time, but not enough to allow digestive juices to reflux into the stomach. In many cases of bile reflux, the valve doesn’t close properly, and bile washes back into the stomach.
Bile reflux into the esophagus
Bile and stomach acid can reflux into the esophagus when another muscular valve, the lower esophageal sphincter, malfunctions. The lower esophageal sphincter separates the esophagus and stomach. The valve normally opens just long enough to allow food to pass into the stomach. But if the valve weakens or relaxes abnormally, bile can wash back into the esophagus.
What leads to bile reflux?
Bile reflux may be caused by:
- Surgery complications. Gastric surgery, including total removal of the stomach (gastrectomy) and gastric bypass surgery for weight loss, is responsible for most bile reflux.
- Peptic ulcers. A peptic ulcer can block the pyloric valve so that it doesn’t open enough to allow the stomach to empty as quickly as it should. Stagnant food in the stomach can lead to increased gastric pressure and allow bile and stomach acid to back up into the esophagus.
- Gallbladder surgery (cholecystectomy). People who have had their gallbladders removed have significantly more bile reflux than do people who haven’t had this surgery.
What increases my risk for bile reflux?
Please discuss with your doctor for further information.
Diagnosis & treatment
The information provided is not a substitute for any medical advice. ALWAYS consult with your doctor for more information.
How is bile reflux diagnosed?
A description of your symptoms is often enough for your doctor to diagnose a reflux problem. But distinguishing between acid reflux and bile reflux is difficult and requires further testing. You’re also likely to have tests to check for damage to your esophagus and stomach, as well as for precancerous changes.
Tests may include:
- A thin, flexible tube with a camera (endoscope) is passed down your throat. The endoscope can show peptic ulcers or inflammation in your stomach and esophagus. Your doctor also may take tissue samples to test for Barrett’s esophagus or esophageal cancer.
- Ambulatory acid tests. These tests use an acid-measuring probe to identify when, and for how long, acid refluxes into your esophagus.
In one test, a thin, flexible tube (catheter) with a probe at the end is threaded through your nose into your esophagus.
In another (the Bravo test), the probe is attached to the lower portion of your esophagus during endoscopy. Ambulatory acid tests can help your doctor rule out acid reflux but not bile reflux.
- Esophageal impedance. This test measures whether gas or liquids reflux into the esophagus. It’s helpful for people who regurgitate substances that aren’t acidic (such as bile) and can’t be detected by an acid probe. As in a standard probe test, esophageal impedance uses a probe that’s placed into the esophagus with a catheter.
How is bile reflux treated?
Lifestyle adjustments and medications can be very effective for acid reflux, but bile reflux medications is harder to treat. There is little evidence assessing the effectiveness of bile reflux treatments, in part because of the difficulty of establishing bile reflux as the cause of symptoms.
- Ursodeoxycholic acid. This medication helps promote bile flow. It may lessen the frequency and severity of your symptoms.
- Bile acid sequestrants. Doctors often prescribe bile acid sequestrants, which disrupt the circulation of bile, but studies show that these drugs are less effective than other treatments. Side effects, such as bloating, may be severe.
- Proton pump inhibitors. These medications are often prescribed to block acid production, but they don’t have a clear role in treating bile reflux.
Doctors may recommend surgery if medications fail to reduce severe symptoms or there are precancerous changes in your esophagus. Some types of surgery can be more successful than others, so be sure to discuss the pros and cons carefully with your doctor.
The options include:
- Diversion surgery (Roux-en-Y). This procedure, which is also a type of weight-loss surgery, may be recommended for people who have had previous gastric surgery with pylorus removal. In Roux-en-Y, surgeons make a new connection for bile drainage farther down in the small intestine, diverting bile away from the stomach.
- Anti-reflux surgery (fundoplication). The part of the stomach closest to the esophagus (fundus) is wrapped and then sewn around the lower esophageal sphincter. This procedure strengthens the valve and can reduce acid reflux. There is little evidence about the surgery’s effectiveness for bile reflux.
Lifestyle changes & home remedies
What are some lifestyle changes or home remedies that can help me manage bile reflux?
The following lifestyles and home remedies might help you cope with bile reflux:
- Stop smoking. Smoking increases the production of stomach acid and dries up saliva, which helps protect the esophagus.
- Eat smaller meals. Eating smaller, more-frequent meals reduces pressure on the lower esophageal sphincter, helping to prevent the valve from opening at the wrong time.
- Stay upright after eating. After a meal, waiting two to three hours before lying down allows time for your stomach to empty.
- Limit fatty foods. High-fat meals relax the lower esophageal sphincter and slow the rate at which food leaves your stomach.
- Avoid problem foods and beverages. Some foods increase the production of stomach acid and may relax the lower esophageal sphincter. Among the foods with this effect are caffeinated and carbonated drinks, chocolate, citrus foods and juices, vinegar-based dressings, onions, tomato-based foods, spicy foods and mint.
- Limit or avoid alcohol. Drinking alcohol relaxes the lower esophageal sphincter and irritates the esophagus.
- Lose excess weight. Heartburn and acid reflux are more likely to occur when excess weight puts added pressure on your stomach.
- Raise your bed. Sleeping with your upper body raised 4 to 6 inches (10 to 15 centimeters) may help prevent reflux symptoms. Raising the head of your bed with blocks or sleeping on a foam wedge is more effective than is using extra pillows.
- When you’re under stress, digestion slows, possibly worsening reflux symptoms. Relaxation techniques, such as deep breathing, meditation or yoga, may help.
If you have any questions, please consult with your doctor to better understand the best solution for you.
Hello Health Group does not provide medical advice, diagnosis or treatment.
Review Date: September 13, 2017 | Last Modified: December 9, 2019
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