Bile Reflux


A digestive fluid called bile, which is generated in your liver, backs up into your stomach and, in certain circumstances, the tube that joins your mouth and stomach, causing bile reflux (esophagus).

Gastric acid (stomach acid) that refluxes into your esophagus may be accompanied by bile reflux. Gastroesophageal reflux disease (GERD), a potentially dangerous condition that involves irritation and inflammation of esophageal tissue, may result from stomach reflux.

Bile Reflux: Causes

Bile is necessary for the body's digestion of lipids, the removal of some poisons, worn-out red blood cells, and other waste products. Your liver makes bile, which your gallbladder stores.

Any amount of fat in your meal causes your gallbladder to produce bile, which travels down a tiny tube and into the top portion of your small intestine (duodenum).

Reflux of Bile into the Stomach

In the duodenum, bile and food combine before entering the small intestine. The thick muscular ring known as the pyloric valve, which is placed at the stomach's outflow, typically just minimally opens, allowing about an eighth of an ounce (or 3.75 milliliters) or less of liquid food to pass through at a time without allowing digestive fluids to reflux into the stomach.

Reflux of Bile into the Esophagus

When the lower esophageal sphincter, another muscle valve, is dysfunctional, bile and stomach acid can reflux into the esophagus. The stomach and esophagus are separated by the lower esophageal sphincter.

Bile reflux may result from −

  • Surgical problems. 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.

  • Stomach ulcers. The pyloric valve can become blocked by a peptic ulcer, making it unable to open or close correctly. 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.

Bile Reflux: Symptoms

It might be challenging to discern between stomach acid reflux and bile reflux. The two illnesses can happen simultaneously, and their indications and symptoms are identical.

Signs and symptoms of bile reflux include −

  • Pain in the upper abdomen that might be bad

  • A burning feeling in your chest that occasionally travels to your neck as well as a sour taste in your mouth are symptoms of frequent heartburn.

  • Nausea

  • Vomiting a yellow-green liquid (bile)

  • Cough or hoarseness

  • Unwanted loss of weight

Bile Reflux: Risk Factors

The major risk factors include −

  • GERD. The most common cause of this illness, which results in esophageal irritation and inflammation, is too much acid, though bile may also be present. When patients don't respond at all or only partially to potent acid-suppressant drugs, bile is frequently suspected of being a factor in GERD.

  • Esophageal Barrett's. This severe illness can develop when tissue in the lower esophagus is damaged over time by stomach acid, bile, or both. The chance of the injured esophagus cells developing cancer is enhanced. Bile reflux and Barrett's esophagus have also been connected in investigations on animals.

  • Carcinoma of the esophagus. Acid reflux, bile reflux, and esophageal cancer are all related, albeit the latter may not be identified until it is well advanced. Bile reflux alone has been demonstrated in animal experiments to result in esophageal cancer.

Bile Reflux: Diagnosis

To diagnose bile reflux, your doctor may suggest the following tests −

  • Endoscopy. Your throat is probed with an endoscope, a skinny, flexible tube with a camera. Bile, peptic ulcers, or inflammation in your stomach or esophagus can all be seen using the endoscope. Additionally, your doctor could collect tissue samples to check for esophageal cancer or Barrett's esophagus.

  • In-person acid testing. To determine how often and how long acid refluxes into your esophagus, these tests employ an acid-measuring probe. However, bile reflux cannot be ruled out with ambulatory acid testing. One test involves inserting a thin, flexible tube (catheter) with a probe into your esophagus through your nose. Over the course of 24 hours, the probe detects the amount of acid in your esophagus.

  • Esophageal resistance. This examination determines if liquids or gases reflux into the esophagus. It is beneficial for those who frequently regurgitate non-acidic substances (like bile) that are invisible to an acid probe. Esophageal impedance utilizes a probe that is inserted into the esophagus using a catheter, much like in a normal probe test.

Bile Reflux: Treatment

Depending on the severity, your doctor may suggest medications or surgical procedures to treat the problem of bile reflux.

Medications

  • Acid ursodeoxycholic. The frequency and intensity of your symptoms could be lessened by this drug.

  • Sucralfate. The lining of the stomach and esophagus may develop a shield of protection from this medicine against bile reflux.

  • Acid sequestrants for bile. Bile acid sequestrants, which stop the flow of bile, are frequently prescribed by doctors, however, research reveals that they are less successful than other therapies. There may be serious side effects, such as extreme bloating.

Surgical Procedures

  • Surgery to divert. To redirect bile away from the stomach during this kind of surgery, a surgeon makes a new link for bile drainage further down in the small intestine.

  • Surgery to treat reflux. The lower esophageal sphincter is wrapped and sewn together with the portion of the stomach that is closest to the esophagus. Strengthening the valve, this surgery helps lessen acid reflux. There isn't much proof that the operation works to stop bile reflux, though.

Bile Reflux: Prevention

You can take the following preventive measures to avoid the problem of bile reflux −

  • Give up smoking. Smoking causes saliva to dry up and the production of stomach acid to rise, which helps to protect the esophagus.

  • Consume smaller meals. The lower esophageal sphincter is less stressed when smaller, more frequent meals are consumed, which helps keep the valve from opening when it shouldn't.

  • Remain standing after eating. When you wait two to three hours after eating, your stomach has time to empty.

  • Eat less greasy meals. High-fat meals loosen the lower esophageal sphincter and cause your stomach to empty more slowly.

  • Stay away from unhealthy meals and drinks. Some meals may boost stomach acid production and loosen the lower esophageal sphincter. Caffeinated and carbonated beverages, chocolate, citrus fruits and juices, vinegar-based dressings, onions, tomato-based dishes, and spicy foods should all be avoided.

  • Limit or stay away from alcohol. Alcohol consumption irritates the esophagus and relaxes the lower esophageal sphincter.

  • Reduce your weight. When you are overweight and your stomach is under more strain, heartburn, and acid reflux are more likely to happen.

  • Elevate your bed. Reflux symptoms may reduce if you sleep with your upper body lifted by 4 to 6 inches (10 to 15 cm). It is more beneficial to sleep on a foam wedge or raise the head of your bed with blocks rather than adding more pillows.

  • Relax. Stress slows digestion, which might make reflux symptoms worse. Deep breathing, meditation, and yoga, among other relaxation methods, may be beneficial.

Conclusion

In clinical practice, bile reflux is a common but poorly understood condition. There are often two components to bile reflux events. One is reflux, which is thought to be related to gastroduodenal dysmotility, a condition of the hormones that regulate the gastroduodenal, or operations. The other is inflammation, which mostly results from bile acid and lysolecithin activation.

Dr. Durgesh Kumar Sinha
Dr. Durgesh Kumar Sinha

MBBS MS [ OPHTHALMOLOGY ]

Updated on: 14-Jul-2023

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