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BILE REFLUX

Bile reflux is a condition in which the bile backs up into the stomach and esophagus. Bile is a digestive liquid produced in the liver. Bile reflux is accompanied by acid reflux, which is the reflux of stomach acids into the esophagus. Bile juice usually gets mixed with food in the duodenum and enters the small intestine through the pyloric valve, which opens slightly to allow liquefied food into the stomach. In the case of bile reflux, the valve does not close properly and the bile refluxes back into the stomach. This occurs due to malfunctioning of lower esophageal sphincter (which separates the esophagus and stomach). The weakened valve leads to backwash of bile into the esophagus. Bile reflux can lead to complications such as gastroesophageal reflux disease (GERD), Barrett’s esophagus, and esophageal cancer.

Signs and Symptoms

The symptoms of acid reflux and bile reflux are similar and hence it is difficult to distinguish both the conditions. Severe abdominal pain accompanied by frequent heart burn is the common symptom of bile reflux. Other symptoms include:

  • Nausea
  • Vomiting
  • Cough
  • Hoarseness
  • Unintentional weight loss
  • Pain in the upper abdominal area

If the patient is left untreated, he or she may develop health complications like GERD which causes inflammation and irritation of the stomach, Barrett's esophagus where esophageal tissue is damaged, and esophageal cancer.

Causes

The causes of bile reflux include:

  • Surgical Complications: Gastrectomy and gastric bypass surgery are the most common causes of stomach and esophagus bile reflux. Patients who had a cholecystectomy (removal of the gallbladder) are more susceptible to bile refluxes.
  • Peptic Ulcers: A peptic ulcer blocks the pyloric valve and doesn’t allow the stomach to empty up. Stagnant food in the stomach leads to increased gastric pressure. Thereby, bile backs up into the esophagus.

Diagnosis

As the signs and symptoms of acid reflux and bile reflux are similar, the doctor performs appropriate tests to confirm the disease.

  • Endoscopy: A thin and flexible tube is passed down the throat to check the presence of peptic ulcers or any inflammation in the stomach and esophagus.
  • Ambulatory Acid Tests: In this test, a thin, flexible tube with a probe is inserted into the esophagus to measure the acid and to test for how long acid refluxes into the esophagus.  
  • Esophageal Impedance: A probe is placed into the esophagus with a catheter to measure whether gas or liquids reflux into the esophagus.

Treatment

Lifestyle modifications may not be effective in treating bile reflux. The various treatment options include:

Medications

  • Ursodeoxycholic Acid: It helps to promote the bile flow and to decrease the frequency and severity of the symptoms.
  • Bile Acid Sequestrants: These drugs interrupt the bile circulation
  • Proton Pump Inhibitors: These medications block the acid production

If the condition does not manage by medications, the doctor would recommend surgical options which include:

Surgery

  • Anti-reflux Durgery (fundoplication): In this procedure, the fundus is wrapped and sewed around the lower esophageal sphincter to strengthen the valve and reduce the 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.

Lifestyle and Home Remedies

Certain lifestyle modifications may help ease the symptoms of bile reflux.

  • Avoid smoking as smoking increases the stomach acid production and dries up the saliva, which protects the esophageal lining
  • Eat smaller and more frequent meals to reduce the pressure on lower esophageal sphincter
  • Avoid sleeping or lying down soon after a meal
  • Avoid foods such as carbonated beverages, citrus fruits, and juices as they increase stomach acid production
  • Avoid alcohol as it irritates esophagus
  • Try to lose weight as excess weight increases pressure on abdomen
  • Avoid stress by practicing deep breathing, meditation, and yoga
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