Reflux, Bile

Bile reflux is a condition where bile, a digestive fluid produced by the liver and stored in the gallbladder, flows upward from the small intestine into the stomach and sometimes into the esophagus.

Causes

• Damage to the pyloric valve, which separates the stomach from the small intestine, allowing bile to flow back into the stomach
• Gallbladder removal (cholecystectomy)
• Gastroesophageal reflux disease (GERD)
• Stomach surgery, such as gastrectomy or gastric bypass
• Certain medications, such as antihistamines and pain relievers

Symptoms

• Frequent heartburn
• Upper abdominal pain
• Nausea and vomiting
• Bloating and gas
• Hoarseness or a sore throat
• Coughing or wheezing
• Difficulty swallowing (dysphagia)

Diagnosis

Diagnosis of bile reflux is typically made through a combination of:

• Medical history and physical examination
• Endoscopy, which involves inserting a flexible tube with a camera into the mouth to visualize the esophagus, stomach, and small intestine
• Ambulatory acid probe tests, which measure the amount of acid in the esophagus
• Imaging studies, such as X-rays or computed tomography (CT) scans

Treatment

Treatment for bile reflux typically involves a combination of lifestyle modifications and medications:

• Dietary changes, such as avoiding fatty or spicy foods, eating smaller meals, and avoiding lying down after eating
• Medications to reduce stomach acid, such as proton pump inhibitors (PPIs) or histamine-2 (H2) blockers
• Ursodeoxycholic acid, a medication that helps reduce bile production
• In some cases, surgery may be necessary to repair the pyloric valve or remove the gallbladder

Complications

If left untreated, bile reflux can lead to complications such as:

• Esophagitis, an inflammation of the esophagus
• Stricture, a narrowing of the esophagus
• Barrett's esophagus, a precancerous condition
• Gastritis, an inflammation of the stomach lining