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What is Bile Reflux?

By J.M. Willhite
Updated Mar 03, 2024
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Bile reflux is a potentially serious condition that occurs when bile flow within the upper digestive system becomes impaired. Often presenting with acid reflux, symptoms of bile reflux cause stomach inflammation and discomfort. Treatment usually involves the administration of medications to alleviate symptoms. Severe presentations of bile reflux may necessitate surgery to prevent further damage to the upper digestive system.

To aid with digestion, the liver produces an acidic substance known as bile, which stays in the gallbladder until it is needed to metabolize digested food. The pyloric valve, located between the bile duct and the duodenum, serves as the main tributary controlling bile flow into the upper digestive system. When the pyloric valve malfunctions, the resulting backward flow of excessive bile can cause stomach inflammation. If the backwash of bile is sufficient and one’s esophageal sphincter is not working properly, esophageal inflammation and erosion may also result. In most cases, individuals who have had surgery on their gastrointestinal tract or been diagnosed with a peptic ulcer have a significantly higher chance for developing bile reflux.

Symptomatic individuals will generally receive a diagnosis of bile reflux following the administration of extensive diagnostic testing. Imaging tests, including an endoscopy, are usually employed to evaluate the condition of one’s upper digestive system by checking for signs of inflammation and ulceration. Due to the associated risk for esophageal cancer, tissue samples may also be obtained from the esophagus to check for markers indicative of malignancy.

Individuals with this condition will often experience patterned signs and symptoms that can be easily mistaken for those associated with acid reflux. Usually, someone with bile reflux will experience abdominal discomfort accompanied by recurrent episodes of heartburn. Some individuals may develop feelings of nausea or demonstrate hoarseness. Due to the unpleasantness of symptoms, individuals may even alter their eating habits in order to avoid symptom onset, which can inadvertent weight loss.

Bile reflux symptoms should not be ignored due to the serious risks for complications. Those who experience chronic symptoms are considered to be at an increased risk for developing gastritis, or stomach inflammation, and gastroesophageal reflux disease (GERD). Extensive esophageal damage can also contribute to the development of esophageal stricture and malignancy.

Generally, individuals with bile reflux will experience relief with the use of prescription medications designed to inhibit bile production and reflux. Medications, such as ursodeoxycholic acid, may be given to promote digestion and alleviate abdominal discomfort. Those who demonstrate severe reflux symptoms may undergo surgery. A common procedure known as diversion surgery involves rerouting one’s bile flow from the stomach to the lower intestine. Individuals with esophageal damage may undergo a surgical procedure known as fundoplication to increase their lower esophageal pressure, thus inhibiting the reflux of acid from the stomach into the esophagus.

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