Having stomach discomfort can be a nuisance. It may be a usual event for some people to have a feeling that there is something left on the throat or feel fluid travelling up the throat after eating food, especially food in big amounts. There are many conditions that may affect the digestive system including bile reflux. You may be familiar with stomach acid reflux but bile reflux may seem unusual to most people. In this DoctorOnCall’s article, we will learn more about bile reflux.
Bile reflux is also known as duodenogastroesophageal reflux (DGER). Bile reflux occurs when the bile secreted into the duodenum moves backwards (retrograde) into the stomach and potentially into the esophagus (food pipe). To understand a bit better on bile reflux, you might want to know what and how bile works.
Bile is a greenish yellow fluid that functions in digestion and eliminating waste products such as excess cholesterol and haemoglobin from the body. Bile flows out of the liver through left and right hepatic cuts which come together to form a common hepatic duct. This duct will then join with a duct connected to the gallbladder known as cystic duct to form a common bile duct. Common bile duct will release bicarbonate and water into bile. Bile juice gets mixed with food in the duodenum and enters the small intestine through a pyloric valve. The pyloric valve is slightly open to enable liquified food entering the stomach.
In case of bile reflux, the valve does not close properly. This leads to the bile washes back into the stomach. This is resulted from the lower esophageal sphincter (a ringlike muscle that separates the esophagus and stomach) malfunctions. The weakened valve then leads to the backwash of bile into the esophagus.
Bile reflux is common in those who have had surgery to remove their gallbladder or those who have undergone gastric surgery such as gastrectomy (removal of stomach either partially or in total) or gastric bypass surgery for weight loss. Peptic ulcer that blocks the pyloric valve also leads to increased gastric pressure and ultimately bile reflux. Bile reflux is a condition that is more severe in patients with gastroesophageal reflux disease (acid reflux) or also known as GERD, particularly in severe esophagitis (inflammation of the esophagus) and/or Barrett esophagus (resulted from long-term exposure to stomach acid). Bile reflux is very infrequent in healthy individuals.
Symptoms of bile reflux are similar to GERD and even in some cases, may exist together with GERD. Symptoms include burning sensation in the chest that lasts more than 2 times a week or persists over a long period of time, upper abdominal pain, hoarseness, nausea and cough. However, there are symptoms that make bile reflux easier to detect such as vomiting greenish-yellow fluid (bile) and unintentional weight loss. Patients who are undergoing treatment for GERD but are not experiencing complete relief of symptoms, should get checked by doctors for the possibility of bile reflux.
Since it is difficult to distinguish bile reflux from acid reflux based on symptoms alone, doctors often run additional tests such as endoscopy to get a closer look of esophagus and other structures related. Esophageal impedance is another test to identify presence of gas or liquids reflux into the esophagus. Doctors may also use the Bilitec monitoring system to evaluate changes in the colour of the reflux in the esophagus.
Patients with bile reflux will want to know ways on getting rid of bile reflux. Since there are no formal guidelines in treating patients with bile reflux, patients are typically treated similarly to those with traditional GERD. Treatment options include proton pump inhibitor, H2 blockers, prokinetics and baclofen. Ursodeoxycholic acid may be prescribed in promoting bile flow. If bile reflux does not subside with medications, doctors will recommend surgical options such as anti-reflux surgery.
Doctors usually suspect bile reflux when a patient does not respond to typical treatment with GERD management. Contrary to acid reflux, bile reflux may not typically respond to lifestyle changes such as diet, weight loss, smoking cessation and reduced drinking alcohol. Medications used to reduce acid production such as in GERD, may not work for bile reflux except when a patient does have GERD and bile reflux at the same time. Even so, only partial relief can be provided by lifestyle changes and medications if patients have both acid and bile reflux.
It is important to treat bile reflux. When left untreated, bile reflux causes more damage to the esophagus. This will lead to high risk for patients to develop Barrett esophagus. It is known that the more bile reflux a patient has, the higher the risk for development of Barrett esophagus. Barrett esophagus can cause great danger as it may develop into precancerous changes and finally to esophageal cancer. It is important for patients with symptoms of bile reflux to get checked by a doctor and to adhere to treatment as planned or advised by doctors.
