Filed under: Digestive Health
Bile reflux occurs when bile — a digestive liquid produced in your liver — backs up (refluxes) into your stomach and esophagus (the tube that connects your mouth and stomach). Bile reflux may accompany acid reflux, the medical term for the backwash of stomach acids into your esophagus.
Whether bile is important in reflux is controversial. Bile is often implicated as a 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. Studies in lab animals indicate that over time, bile reflux may have serious consequences, potentially increasing your risk of esophageal cancer.
Unlike acid reflux, bile reflux usually can't be completely controlled by changes in diet or lifestyle. Instead, bile reflux is most often managed with medications or, in severe cases, with surgery.
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.
Bile reflux signs and symptoms include:
When to see a doctor
Make an appointment with your doctor if you frequently experience symptoms of reflux, or if you're losing weight without trying.
If you've been diagnosed with gastroesophageal reflux disease (GERD) but aren't getting adequate relief from your medications, call your doctor. You may need additional treatment for 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
At the same time that bile flows into the duodenum, food enters 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:
Sticky mucous coats and protects the lining of your stomach from the corrosive effects of stomach acid. The esophagus lacks this protection, so acid and bile reflux can seriously damage esophageal tissue. The combination of bile and acid reflux increases the risk of complications, including:
Make an appointment with your doctor if you have signs or symptoms common to bile reflux. After your doctor's initial evaluation, you may be referred to a specialist in digestive disorders (gastroenterologist).
Here's some information to help you prepare for your appointment and what to expect from your doctor.
What you can do
Don't hesitate to ask questions during your appointment. Some questions to ask your doctor include:
What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may give you time to go over points you want to spend more time on. You may be asked:
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:
Although treatments for acid reflux can be very effective, medications for bile reflux may not be helpful for many people. 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.
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:
Unlike acid reflux, bile reflux seems less related to lifestyle factors. But many people experience both acid reflux and bile reflux, so your symptoms may be eased by lifestyle changes:
Many people with frequent heartburn use over-the-counter or alternative therapies for symptom relief. Remember that even natural remedies can have risks and side effects, including potentially serious interactions with prescription medications. Always do careful research and talk with your doctor before trying an alternative therapy.
Although no alternative therapies have been found specifically to relieve bile reflux, some may help protect against and relieve esophageal inflammation. If you decide to start any of these therapies, discuss them with your doctor. They include: