Bile reflux

What is Bile Reflux?
Bile Reflux occurs when bile (a greenish digestive fluid produced in the liver) flows backward from the small intestine into the stomach and esophagus.

It often happens alongside Acid Reflux, but they are different. Unlike acid reflux, bile reflux usually cannot be controlled by diet or lifestyle changes alone.

Symptoms

Because it often occurs with acid reflux, symptoms are similar. However, key signs of Bile Reflux include:

• Upper Abdominal Pain: Can be severe.
• Frequent Heartburn: A burning sensation that spreads to the throat.
• Greenish-Yellow Vomit: This is the hallmark sign. Regurgitating bile implies the fluid is coming from the intestine, not just the stomach.
• Unintended Weight Loss: Due to digestion issues or avoiding food to prevent pain.

Causes

Bile is released into the small intestine to digest fats. A valve (the Pyloric Valve) usually prevents it from backing up into the stomach. Reflux happens when this valve fails.

Common Triggers

• Gallbladder Surgery (Cholecystectomy): People who have had their gallbladders removed have significantly higher rates of bile reflux.
• Gastric Surgery: Weight loss surgeries (like Gastric Bypass) or total stomach removal often alter the valves, allowing bile to back up.
• Peptic Ulcers: An ulcer can block the pyloric valve, preventing the stomach from emptying properly.

Complications

⚠️ CANCER RISK
Bile is harsh on the esophagus. Long-term exposure increases the risk of:

• Barrett's Esophagus: Damaged cells that can become precancerous.
• Esophageal Cancer: Studies suggest a link between bile reflux and cancer risk.

Diagnosis

Since symptoms mimic Acid Reflux, doctors need specific tests to tell the difference:

• Endoscopy: A camera checks for inflammation or bile pooling in the stomach.
• Esophageal Impedance Test: This measures if gas or liquids are regurgitating into the esophagus. It is useful because standard acid probes cannot detect bile (which is not acidic).

Treatment

Standard acid reflux medicines (PPIs) often do not work for bile reflux because bile is not an acid.

1. Medications

• Bile Acid Sequestrants: Medications that bind to bile and disrupt its circulation.
• Ursodeoxycholic Acid: Promotes bile flow to reduce symptom severity.
• Prokinetic Agents: Help the stomach empty faster so bile doesn't sit there.

2. Surgery

If medications fail or precancerous changes appear, surgery is the next step:

• Diversion Surgery (Roux-en-Y): Surgeons create a new connection for bile drainage further down the intestine, diverting it away from the stomach. This is often the most effective cure for severe cases.

Disclaimer: The content provided on this blog is for informational purposes only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician regarding any medical condition.