Bile reflux

Bile reflux occurs when bile — a digestive liquid produced in your liver — backs up (refluxes) into your stomach and, in some cases, into the tube that connects your mouth and stomach (esophagus).

Bile reflux may accompany the reflux of stomach acid (gastric acid) into your esophagus. Gastric reflux may lead to gastroesophageal reflux disease (GERD), a potentially serious problem that causes irritation and inflammation of esophageal tissue.

Unlike gastric acid reflux, bile reflux can't be completely controlled by changes in diet or lifestyle. Treatment involves medications or, in severe cases, surgery.

Bile reflux can be difficult to distinguish from gastric acid reflux. The signs and symptoms are similar, and the two conditions may occur at the same time.

Bile reflux signs and symptoms include:

• Upper abdominal pain that may be severe
• Frequent heartburn — a burning sensation in your chest that sometimes spreads to your throat, along with a sour taste in your mouth
• Nausea
• Vomiting a greenish-yellow fluid (bile)
• Occasionally, a cough or hoarseness
• Unintended weight loss

Make an appointment with your doctor if you frequently experience symptoms of reflux, or if you're losing weight without trying.

If you've been diagnosed with gastroesophageal reflux disease (GERD) but aren't getting enough relief from your medications, call your doctor. You may need additional treatment for bile reflux.

Bile is essential for digesting fats and for eliminating worn-out red blood cells and certain toxins from your body. Bile is produced in your liver and stored in your gallbladder.

Eating a meal that contains even a small amount of fat signals your gallbladder to release bile, which flows through a small tube into the upper part of your small intestine (duodenum).

Bile reflux into the stomach

Bile and food mix in the duodenum and enter your small intestine. The pyloric valve, a heavy ring of muscle located at the outlet of your stomach, usually opens only slightly — enough to release about an eighth of an ounce (about 3.75 milliliters) or less of liquefied food at a time, but not enough to allow digestive juices to reflux into the stomach.

In cases of bile reflux, the valve doesn't close properly, and bile washes back into the stomach. This can lead to inflammation of the stomach lining (bile reflux gastritis).

Bile reflux into the esophagus

Bile and stomach acid can reflux into the esophagus when another muscular valve, the lower esophageal sphincter, doesn't work properly. The lower esophageal sphincter separates the esophagus and stomach. The valve normally opens just long enough to allow food to pass into the stomach. But if the valve weakens or relaxes abnormally, bile can wash back into the esophagus.

What leads to bile reflux?

Bile reflux may be caused by:

• Surgery complications. Stomach surgery, including total or partial removal of the stomach and gastric bypass surgery for weight loss, is responsible for most bile reflux.
• Peptic ulcers. A peptic ulcer can block the pyloric valve so that it doesn't open or close properly. Stagnant food in the stomach can lead to increased gastric pressure and allow bile and stomach acid to back up into the esophagus.
• Gallbladder surgery. People who have had their gallbladders removed have significantly more bile reflux than do people who haven't had this surgery.

Bile reflux gastritis has been linked to stomach cancer. The combination of bile reflux and acid reflux also increases the risk of the following complications:

• GERD. This condition, which causes irritation and inflammation of the esophagus, is most often due to excess acid, but bile may be mixed with the acid.

  Bile is often suspected of contributing to GERD when people respond incompletely or not at all to powerful acid-suppressant medications.

• Barrett's esophagus. This serious condition can occur when long-term exposure to stomach acid, or to acid and bile, damages tissue in the lower esophagus. The damaged esophageal cells have an increased risk of becoming cancerous. Animal studies have also linked bile reflux to Barrett's esophagus.
• Esophageal cancer. There's a link between acid reflux and bile reflux and esophageal cancer, which may not be diagnosed until it's quite advanced. In animal studies, bile reflux alone has been shown to cause cancer of the esophagus.