Bile Reflux is a type of condition when the bile — a greenish-yellow digestive liquid produced in the liver refluxes or backs up from the duodenum into the stomach and, in some cases, even in the esophagus, i.e., the tube that connects our mouth with the stomach. Bile is usually stored in the gall bladder and consists of bile salts and bile pigments that are extremely necessary for the absorption and emulsification of fats.
Quite often bile reflux fluid may also be accompanied with acid reflux of gastric acid into the esophagus. The reflux of the gastric juice can often lead to a severe condition called Gastro-Esophageal Reflux Disease (GERD) that causes inflammation and irritation of the esophagus. But unlike acid reflux, bile reflux cannot be treated by lifestyle modifications rather it involves prescribed medications and sometimes even surgical procedures.
The most primary cause behind bile reflux is when there is a damage to the valves or sphincters that control the movement of food from esophagus to stomach and then to the duodenum. But sometimes it can also happen due to food poisoning, abnormal movements of duodenum or an operative stoma (an artificial opening made through surgery).
Certain causative factors that increase the chances of Bile Reflux include:
Peptic Ulcers: Getting diagnosed with peptic ulcer can make a person more prone to Bile Reflux. These ulcers can block the pyloric valve leading to accumulation of stagnant food in the stomach which eventually increases gastric pressure and allows bile and stomach acid to back up into the esophagus.
Surgical Complications: People undergoing through a stomach surgery, including total or partial removal of the stomach or a gastric bypass surgery for weight loss, is more at risk of having bile reflux. Even people who have underwent a gall bladder surgery faces bile reflux in the later stages.
Lifestyle Choices: Consumption of too much alcohol or tobacco in some form increases the chances of getting bile reflux.
The common signs and symptoms of Bile reflux are quite similar to acid reflux hence they are difficult to diagnose. These include:
- Epigastric pain (pain in the upper abdomen)
- Frequent heartburn
- Burning sensation in the stomach
- Bilious vomiting (throwing up of a greenish-yellow bile fluid)
- Occasionally, a cough or hoarseness
- Unintended weight loss
If the condition is left untreated for a long time, it can eventually lead to:
- Gastric Esophageal Reflux Disease (GERD)
- Barrett’s Esophagus
- Bleeding stomach ulcers
- Esophageal Cancer
Diagnosis And Treatment
On noticing any of the above-mentioned signs and symptoms, do consult a doctor for diagnosing the condition properly. The doctor usually does a thorough physical checkup, acknowledges the patient’s past surgical history and conducts some diagnostics to rule out acid reflux. These include:
- Endoscopy: Observing the scarring and inflammation of the esophagus by inserting a thin, flexible tube containing light and camera.
- Bilitec Monitoring System: A device known as photo colorimetric device is used to identify bile reflux.
- Ambulatory Acid Test: This test uses a thin, acid-sensing probe to identify and analyze when, and for how long, acid refluxes or backs up into your esophagus. This test differentiates bile reflux from acid reflux.
- Esophageal Impedance Test: This test uses manometry and pH test to measure whether gas, liquids or bolus refluxes into the esophagus.
Treatment of bile reflux is not as easy as acid reflex which can just be managed by following some lifestyle changes and taking medication. It usually involves:
- Bile acid sequestrants that chiefly disrupts the movement of bile in digestive tract decreasing the reflux.
- Prokinetic agents to speed up gastric emptying by increasing the contractions of small intestine.
- Proton pump inhibitors to reduce acid production and thereby inhibit acid reflux as well.
- Other medications to lessen the frequency and severity of your symptoms. Some of these can even form a protective coating that protects the lining of the stomach and esophagus against bile reflux.
If medications fail to produce desired results, and bile reflux continues to happen, doctors may resort to surgical procedures that includes:
- Diversion surgery (a new connection is created to divert the flow away from stomach)
- Anti-reflux surgery (the part closest to the stomach is wrapped and sutured around the lower esophageal sphincter)