Bile Reflux – What is it, Symptoms and Treatments!

Biliary Reflux – What it is, Symptoms and Treatments of this condition that many are unaware of. In addition, Bile Reflux is a gastrointestinal disorder. occurs when bile — a digestive fluid produced in your liver — backs up (backflows) into your stomach and the tube that connects your mouth and stomach ( esophagus ). Bile reflux can accompany acid reflux , the medical term for the washing back 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-suppressing medications. But there is little evidence to indicate the effects of bile reflux in people.

Unlike acid reflux , bile reflux usually cannot be completely controlled by dietary or lifestyle changes. Treatment involves medication or, in severe cases, surgery.

Causes of Bile Reflux: Bile is a greenish-yellow liquid 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) in the upper part of your small intestine (duodenum).

Bile Reflux in the Stomach: Bile and food mixes into the duodenum and enters the small intestine through the pyloric valve, a strong ring of muscle located at the outlet of the stomach . The pyloric valve usually opens just a little, enough to release about one eight servings (about 3.5 milliliters) of liquefied food at a time, but not enough to allow digestive juices to reflect back into the stomach . In many cases of bile reflux , the valve does not close properly, and bile flows back into the stomach .

Bile Reflux in the Esophagus: Bile and acid in the stomach can cause 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 through the stomach . But if the valve weakens or relaxes abnormally, bile can wash back into the esophagus .

Other possible causes of bile reflux :

Surgical Complications: Gastric surgeries, including total removal of the stomach (gastrectomy) and gastric bypass surgery for weight loss, are responsible for many cases of bile reflux .

Peptic Ulcers: A peptic ulcer can block the pyloric valve so that it does not open wide enough to allow the stomach to empty as quickly as it should. Food stagnant in the stomach can lead to increased gastric pressure and allow bile and stomach acid to back up into the esophagus .

Gallbladder Surgery: People who have had their gallbladder varices removed have significantly more Gallbladder Reflux than people who have not had this surgery.

Symptoms of Bile Reflux: Bile reflux can be difficult to distinguish from acid reflux . The signs and symptoms are similar, and the two conditions can occur at the same time. It is unclear what role bile plays in reflux conditions.

The signs and symptoms of bile reflux include:

• Upper abdominal pain that can be severe
• Frequent acidity – a burning sensation in your chest that sometimes spreads to your throat, along with a sour taste in your mouth
• Nausea
• Vomiting a greenish yellow fluid (bile)
• Occasionally a cough or hoarseness
• involuntary weight loss

When to See a Doctor: Make an appointment with your doctor if you have reflux symptoms frequently, or if you are losing weight without trying.

If you’ve been diagnosed with gastroesophageal reflux disease (GERD) but aren’t getting adequate relief from your medications, talk to your doctor. You may need additional treatment for Biliary Reflux .

Possible  Complications of Bile Reflux: Sticky mucus protects the stomach lining from the corrosive effects of stomach acid . The esophagus lacks this protection, so acid and bile reflux can severely damage esophageal tissue. The combination of Bile Reflux and acid increases the risk of complications, including:

Gastroesophageal Reflux: Occasional heating is usually not a concern. But frequent or continuous burning is the most common symptom of Gastroesophageal Reflux, a potentially serious problem that causes irritation and inflammation of the esophageal tissue (esophagitis). Gastroesophageal reflux is most often due to excess acid. Although bile has been implicated, its importance in reflux is controversial.

Barrett’s Esophagus: This serious condition can occur when prolonged exposure to stomach acid , or both acid and bile, damages tissue in the lower esophagus . Damaged esophageal cells have a higher risk of becoming cancerous. Animal studies have also linked Bile Reflux to the occurrence of Barrett ‘s esophagus .

Esophageal Cancer: This form of cancer may not be diagnosed until it is quite advanced. The possible link between bile reflux and acid reflux and esophageal cancer remains controversial, but many experts think there is a direct connection. In animal studies, Bile Reflux alone has been proven to cause esophageal cancer .

Bile Reflux Diagnoses: A description of your symptoms is usually enough for your doctor to diagnose a Bile Reflux problem . But distinguishing between acid reflux and bile reflux is difficult and requires further testing. You are also likely to have tests to check for damage to the esophagus and stomach , as well as for precancerous changes.

Tests can include:

Endoscopy: A thin, flexible tube with a camera (endoscope) is passed down the throat. The endoscope may show peptic ulcers or inflammation in your stomach and esophagus . Your doctor may also 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 reflux has been in your esophagus .

In one test, a thin, flexible tube (catheter) with a probe on the end is threaded down the nose into the esophagus .

In another (the Bravo test), the probe is attached to the lower portion of the esophagus during endoscopy. Ambulatory acid tests can help your doctor rule out acid reflux , but not bile reflux .

Esophageal Impedance: This test measures the reflux of gas or liquids into the esophagus . It is useful for people who regurgitate substances that are not acidic (such as bile) and cannot be detected by an acid probe. As with a standard probe test, esophageal impedance uses a probe that is placed in the esophagus  with a catheter.

Bile Reflux Treatments: Lifestyle adjustments and medications can be very effective for acid reflux , but medications for bile reflux are more difficult to treat. There is little evidence evaluating the effectiveness of Biliary Reflux treatments , in part due to the difficulty of establishing Biliary Reflux as the cause of symptoms.

Medications: Ursodeoxycholic acid. This medication helps to promote the flow of bile. It can decrease 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 swelling, can be serious.
• Proton Pump Inhibitors: These medications are often prescribed to block acid production, but they do not have a clear role in treating bile reflux .
• Surgical Treatments: Doctors may recommend surgery if medications fail to reduce severe symptoms or there are precancerous changes in your esophagus . Some types of surgery may be more successful than others, so be sure to discuss the pros and cons carefully with your doctor.

Options include:

• Bypass Surgery: 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. At Roux-en-Y, surgeons make a new connection for bile drainage further down the small intestine, diverting bile away from the stomach .
• Anti-reflux Surgery: The part of the stomach closest to the esophagus (bottom) is rolled and then stitched around the lower esophageal sphincter. This procedure strengthens the valve and can reduce acid reflux . There is little evidence on the effectiveness of surgery for bile reflux .