Bile Reflux
Bile reflux is a condition in which the bile backs up into the stomach and/or the esophagus. Bile is a digestive liquid produced by the liver and is used by the intestines to digest food.
Changing the diet or making lifestyle changes may not help with the symptoms of bile reflux. The condition may be managed with medications, but in some cases surgery could also be needed.
This article discusses the symptoms and potential causes of bile reflux. It also covers risk factors and when to seek tests or treatment for your symptoms.
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Acid reflux is a condition that causes stomach acid to flow back up into the esophagus. Bile reflux is a different condition because it occurs when bile flows into the stomach or esophagus. However, both conditions can be present in the same person.
Symptoms of Bile Reflux
The symptoms of bile reflux are similar to several other conditions. For that reason, it’s important to have new symptoms or changes in any digestive symptoms checked out by a healthcare provider.
Some of the symptoms of bile reflux include:
Heartburn (a bad/sour taste in the mouth and burning in the chest or throat)
Hoarse voice
Losing weight without trying
Nausea
Persistent cough
Severe upper abdominal pain
Vomiting bile (greenish-yellow fluid)
Causes of Bile Reflux
There are several reasons that someone might develop bile reflux. The underlying cause may be:
A structural problem with the valve in the stomach (pyloric valve), which can be due to peptic ulcers
A structural problem with a valve in the esophagus (lower esophageal sphincter)
A surgical complication
Surgical complications: People who have had surgery on their stomach may develop bile reflux. Weight loss procedures (bariatric surgery) are the most common surgeries resulting in bile reflux. Surgery to remove the gallbladder is also associated with a higher risk of bile reflux.
Stomach reflux: The pyloric valve is located where the stomach meets the small intestine. It opens to allow food to pass from the stomach into the first part of the small intestine (the duodenum).
It’s a small opening, and it’s only supposed to allow the stomach contents to pass one way. However, if the pyloric valve doesn’t close all the way, it could allow bile to flow into the stomach instead of the small intestine.
A peptic ulcer is a sore in the lining of the esophagus, stomach, or duodenum. If an ulcer affects the pyloric valve, it could prevent the valve from opening and closing properly. This could allow bile to back up into the stomach.
Esophageal reflux: The lower esophageal sphincter is a valve at the bottom of the esophagus. It opens up to allow food to pass from the esophagus into the stomach. Food is not supposed to come back up into the esophagus. However, if the lower esophageal sphincter is weak or too relaxed, food and bile can come back up into the esophagus.
How to Treat Bile Reflux
With other types of reflux, treatment often focuses on changing the diet or other lifestyle factors. However, that won’t help with bile reflux. This is why it’s important to get a diagnosis. However, determining whether symptoms are from bile reflux—and not another type of reflux or a different condition—can be challenging.
Some medications are used to treat bile reflux. Bile reflux isn’t well studied, so it may take some trial and error to find the medication that will work to help get symptoms under control.
Medications
Bile acid sequestrants: These medications might also be called bile acid resins (BAR). They bind with the bile. That causes the bile to become ineffective, and it passes out of the body in stool. These include:
These medications might cause symptoms such as nausea, bloating, or gas that are severe enough that some people may not want to take them.
Carafate (sucralfate): This medication is used to treat peptic ulcers. It works by coating the lining of the stomach and the small intestine. The drug isn’t absorbed by the body, so it is a layer that protects the inside of these organs from being further harmed by the bile.
Actigall or Urso 250 or Urso Forte (ursodiol): This is a type of a bile acid that has an effect on the liver. It is a small part of the overall composition of bile. It has been used to treat certain liver diseases and disorders of the bile ducts. It can have side effects of diarrhea, nausea, or vomiting.
Surgery
Having bile acids flow into the stomach or esophagus can cause damage and inflammation. If this continues for a long time, it can increase cancer risk. Surgery might be considered for people still having symptoms even after trying to treat them with medications. The types include:
Diversion surgery: Diverting the bile duct so it connects at a different part of the small intestine is one surgical option. This means the bile flows into the small intestine farther away from the valve.
Reflux surgery: In this surgery, the lower esophageal sphincter is strengthened. Part of the stomach is used to support the outside of the sphincter. However, it’s still unclear if this surgery is the most effective way to treat bile reflux.
Complications and Risk Factors of Bile Reflux
Over time, having bile reflux can lead to problems in the stomach and esophagus. Exposure to bile can cause inflammation in those areas. This inflammation could lead to complications such as ulcers. Bile reflux could be complicated with also having gastroesophageal acid reflux (GERD).
Having ulcers and inflammation (gastritis) in the stomach from reflux is associated with developing gastric cancer. Ongoing inflammation in the esophagus can lead to a condition called Barrett’s esophagus, which also may increase the risk of cancer.
Some of these risks are not well studied, so how often they occur is still not understood. It’s thought that developing cancer due to bile reflux after having gastric bypass surgery may be uncommon or even rare.
Are There Tests to Diagnose Bile Reflux?
Bile reflux isn’t always easy to diagnose. Reflux might be suspected or diagnosed based on the symptoms. But knowing that it is from bile reflux may take more investigating.
Some of the tests that might be used include:
Bilitec monitoring system: In this test, the color of the reflux in the esophagus is monitored. Bile has a particular color, so from knowing that, it may be possible to diagnose bile reflux.
Esophageal impedance test: In this test, a catheter (a thin tube) is inserted through the nose and into the esophagus. Over 24 hours, the area is monitored, and the presence of bile or how often reflux occurs can be measured.
Esophageal pH test: Measuring the pH level (acidity) of the esophagus may be used to help diagnose acid reflux. It may be done with a catheter placed into the throat or by swallowing a capsule. Lower pH levels in the esophagus may mean there is bile or stomach acid present.
Hepatobiliary iminodiacetic acid (HIDA) scan. This is a test that looks at the bile ducts, gallbladder, and liver. A small amount of radioactive material is injected into the bloodstream. The abdomen is then scanned to see how the tracer moves through the gallbladder and small intestine.
Upper endoscopy. This test looks at the esophagus, stomach, and first section of the small intestine by inserting a thin, flexible tube into the mouth and moving it down through the digestive system. A biopsy (removing a small tissue sample to be analyzed in a lab) can be performed in order to test for inflammation and bile.
When to See a Healthcare Provider
Acid reflux is a common problem and has symptoms that are similar to bile reflux. It might not be possible to tell the difference between the two without testing. Treatments meant for acid reflux may not be helpful for bile reflux.
People should think about seeing a healthcare provider when they’re having upper abdominal symptoms that are ongoing and aren’t getting any better with changing the diet. Bile reflux isn’t treatable with home remedies, so getting a diagnosis from a healthcare provider is going to be the way to get it under control.
If abdominal pain is severe or there are symptoms such as bleeding, vomiting, or diarrhea that won’t stop, see a healthcare provider immediately or go to the emergency room (ER).
Summary
Bile reflux has symptoms that are similar to other, more common conditions such as GERD. However, this condition is more difficult to diagnose and treat, and may be associated with more risks of complications. For that reason, symptoms of reflux that aren’t getting any better may be a reason to seek out a healthcare provider for a diagnosis, to either rule out or diagnose bile reflux.
