March 04, 2015
Lifestyle adjustments and medications can be very effective for acid reflux, but bile reflux medications is harder to treat. There is little evidence assessing the effectiveness of bile reflux treatments, in part because of the difficulty of establishing bile reflux as the cause of symptoms.
- Ursodeoxycholic acid. This medication helps promote bile flow. It may lessen the frequency and severity of your symptoms.
- Bile acid sequestrants. Doctors often prescribe bile acid sequestrants, which disrupt the circulation of bile, but studies show that these drugs are less effective than other treatments. Side effects, such as bloating, may be severe.
- Proton pump inhibitors. These medications are often prescribed to block acid production, but they don't have a clear role in treating bile reflux.
Doctors may recommend surgery if medications fail to reduce severe symptoms or there are precancerous changes in your esophagus. Some types of surgery can be more successful than others, so be sure to discuss the pros and cons carefully with your doctor.
The options include:
- Diversion surgery (Roux-en-Y). This procedure, which is also a type of weight-loss surgery, may be recommended for people who have had previous gastric surgery with pylorus removal. In Roux-en-Y, surgeons make a new connection for bile drainage farther down in the small intestine, diverting bile away from the stomach.
- Anti-reflux surgery (fundoplication). The part of the stomach closest to the esophagus (fundus) is wrapped and then sewn around the lower esophageal sphincter. This procedure strengthens the valve and can reduce acid reflux. There is little evidence about the surgery's effectiveness for bile reflux.
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- Matsuzaki J, et al. Bile acids increase levels of microRNAs 221 and 222, leading to degradation of CDX2 during esophageal carcinogenesis. Gastroenterology. 2013;145:1300.
- Quante M, et al. Barrett esophagus: What a mouse model can teach us about human disease. Cell Cycle. 2012;11:4328.
- Picco MF (expert opinion). Mayo Clinic, Rochester, Minn. Dec. 15, 2014.
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