Bile reflux

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.