Bile reflux

Symptoms & causes Diagnosis & treatment Doctors & departments Care at Vejthani

Overview

Bile reflux occurs when bile, a digestive fluid produced by the liver, flows back into the stomach and sometimes into the esophagus, which is the tube connecting the mouth and stomach. This condition can often accompany the reflux of stomach acid into the esophagus, leading to a more serious condition called gastroesophageal reflux disease (GERD). GERD can cause irritation and inflammation of the esophageal tissue.
In the normal digestive process, everything should flow in one direction, downwards. Valves located at the end of each organ along the digestive tract open to allow food and digestive juices to pass through to the next organ. However, when these valves, known as sphincters, do not function properly, reflux can occur. This means that digestive fluids like bile can flow back into organs where they should not be.
Unlike gastric acid reflux, which can be managed through lifestyle and dietary changes, bile reflux cannot be fully controlled by such measures. Treatment for bile reflux typically involves medications, although in severe cases, surgery may be necessary to address the issue.

Symptoms

Distinguishing between bile reflux and gastric acid reflux can pose a challenge as their signs and symptoms are similar, often leading to overlapping occurrences of the two conditions.

Signs and symptoms of bile reflux include:

Nausea
Greenish or yellowish liquid (bile) vomit
Coughing or hoarseness from time to time
Unexplained weight loss
Potentially severe pain in the upper abdomen
Regular heartburn, which causes a burning sensation in the chest that can occasionally migrate to the neck as well as a sour taste in the mouth.

If you frequently experience symptoms of reflux or are unintentionally losing weight, it is advisable to schedule an appointment with your doctor. Similarly, if you have already been diagnosed with GERD (gastroesophageal reflux disease) but find that your current medications are not providing sufficient relief, it is recommended to contact your doctor as additional treatment for bile reflux may be necessary.

Causes

Bile, an essential component for fat digestion and waste elimination, is produced in the liver and stored in the gallbladder. When you consume a meal containing even a small amount of fat, it triggers the gallbladder to release bile. This bile then travels through a small tube into the upper part of the small intestine, called the duodenum.

Under normal circumstances, the pyloric valve, a muscular ring located at the stomach’s exit, opens only slightly, allowing a small amount of liquefied food to pass through into the small intestine. However, it does not typically permit digestive juices, including bile, to reflux back into the stomach. Unfortunately, in cases of bile reflux, the valve fails to close properly, leading to the backflow of bile into the stomach. This condition can cause inflammation of the stomach lining, known as bile reflux gastritis.

In addition to reflux into the stomach, bile and stomach acid can also flow back into the esophagus when the lower esophageal sphincter, a muscular valve that separates the esophagus from the stomach, malfunctions. Ordinarily, this valve opens briefly to allow food to enter the stomach. However, if the lower esophageal sphincter weakens or relaxes abnormally, bile can regurgitate into the esophagus. This condition is often associated with gastroesophageal reflux disease (GERD).

Bile reflux may also be brought on by:

Surgery complications. The majority of bile reflux is caused by stomach surgery, which includes gastric bypass surgery for weight loss and entire or partial removal of the stomach.
Peptic ulcers. The pyloric valve can become blocked by a peptic ulcer, making it unable to open or close properly. Increased gastric pressure brought on by stagnant food in the stomach can cause bile and stomach acid to back up into the esophagus.
Gallbladder surgery. Compared to others who have not undergone this operation, those who had their gallbladders removed experience much greater bile reflux.

Diagnosis

Diagnosing a reflux problem typically involves providing your doctor with a detailed description of your symptoms and medical history. However, differentiating between acid reflux and bile reflux can be challenging and necessitates additional testing. In addition, your doctor may conduct tests to assess any potential damage to your esophagus and stomach, as well as to detect any precancerous changes.

The diagnostic testing for reflux issues may involve the following procedures:

Endoscopy. During a medical procedure, a slender and pliable tube equipped with a camera, known as an endoscope, is inserted into your throat to examine the condition of your stomach and esophagus. The endoscope allows the doctor to observe the presence of bile, peptic ulcers, or inflammation in these areas. Additionally, the doctor may collect tissue samples for further analysis to test for Barrett’s esophagus or esophageal cancer. To ensure your comfort, you will receive medication to numb and relax you throughout the examination. If necessary, the endoscope can also retrieve tissue samples for laboratory testing.
Esophageal impedance. The purpose of this test is to determine if there is reflux of stomach contents into the esophagus and to determine whether the reflux is acidic or non-acidic. To conduct the test, a small catheter is inserted through your nasal cavity into the esophagus. Your throat will be numbed and relaxed using medication. The catheter remains in place for a duration of 24 hours. Throughout this period, it records the number of reflux episodes, the composition of the refluxed contents, and any resulting symptoms. This test is considered reliable for distinguishing between acid and non-acid reflux.
Hepatobiliary Iminodiacetic Acid (HIDA). lso referred to as scintigraphy, is a radiographic imaging procedure that monitors the movement of bile from the liver to the small intestine. During this test, you will need to recline on a scanner bed for a duration ranging from one to four hours.
Bilitec monitoring system. Through the use of a photo-colorimetric device, this test can identify the presence of bile in esophageal reflux.

Treatment

Treating acid reflux into the esophagus can often be effectively managed through lifestyle changes and medications. However, the treatment of bile reflux poses a greater challenge. The effectiveness of treatments for bile reflux is difficult to assess due to limited evidence, partly because establishing bile reflux as the underlying cause of symptoms is a complex task.

Medications

Sucralfate. The lining of the stomach and esophagus may develop a shield of protection from this medicine against bile reflux.
Ursodeoxycholic acid (UDCA). The frequency and intensity of your symptoms might be lessened by this drug.
Bile acid sequestrants. Bile acid sequestrants, which stop the flow of bile, are frequently prescribed by doctors, however research reveal that they are less effective than alternative therapies. There may be serious side effects, like extreme bloating.
Prokinetic agents. Boost the movement of the small intestine and stomach.
Baclofen. A medicine that lessens your lower esophageal sphincter’s relaxation.

Surgical treatments

If medications are unsuccessful in alleviating severe symptoms or if there are precancerous changes in your stomach or esophagus, doctors may suggest surgery as a possible course of action. It is important to note that the effectiveness of different surgical procedures can vary, so it is crucial to have a thorough discussion with your doctor to weigh the advantages and disadvantages.

Surgery

Potential surgical options to consider include:

Diversion surgery: In this procedure, a new pathway is created in the small intestine to redirect the flow of bile away from the stomach and towards a lower point in the digestive system.
Anti-reflux surgery: This involves wrapping and suturing the upper part of the stomach around the lower esophageal sphincter. By doing so, the valve is reinforced, potentially reducing acid reflux. However, it should be noted that the effectiveness of this surgery for treating bile reflux is not well-supported by substantial evidence.

Diseases & Conditions Bile reflux