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.