A description of your symptoms is often enough for your doctor to diagnose a reflux problem. But distinguishing between acid reflux and bile reflux is difficult and requires further testing. You're also likely to have tests to check for damage to your esophagus and stomach, as well as for precancerous changes.
Tests may include:
- Endoscopy. A thin, flexible tube with a camera (endoscope) is passed down your throat. The endoscope can show peptic ulcers or inflammation in your stomach and esophagus. Your doctor also may take tissue samples to test for Barrett's esophagus or esophageal cancer.
Ambulatory acid tests. These tests use an acid-measuring probe to identify when, and for how long, acid refluxes into your esophagus.
In one test, a thin, flexible tube (catheter) with a probe at the end is threaded through your nose into your esophagus.
In another (the Bravo test), the probe is attached to the lower portion of your esophagus during endoscopy. Ambulatory acid tests can help your doctor rule out acid reflux but not bile reflux.
- Esophageal impedance. This test measures whether gas or liquids reflux into the esophagus. It's helpful for people who regurgitate substances that aren't acidic (such as bile) and can't be detected by an acid probe. As in a standard probe test, esophageal impedance uses a probe that's placed into the esophagus with a catheter.
Lifestyle adjustments and medications can be very effective for acid reflux, but bile reflux 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.
Lifestyle and home remedies
Unlike acid reflux, bile reflux seems unrelated to lifestyle factors. But because many people experience both acid reflux and bile reflux, your symptoms may be eased by lifestyle changes:
- Stop smoking. Smoking increases the production of stomach acid and dries up saliva, which helps protect the esophagus.
- Eat smaller meals. Eating smaller, more-frequent meals reduces pressure on the lower esophageal sphincter, helping to prevent the valve from opening at the wrong time.
- Stay upright after eating. After a meal, waiting two to three hours before lying down allows time for your stomach to empty.
- Limit fatty foods. High-fat meals relax the lower esophageal sphincter and slow the rate at which food leaves your stomach.
- Avoid problem foods and beverages. Some foods increase the production of stomach acid and may relax the lower esophageal sphincter. Among the foods with this effect are caffeinated and carbonated drinks, chocolate, citrus foods and juices, vinegar-based dressings, onions, tomato-based foods, spicy foods and mint.
- Limit or avoid alcohol. Drinking alcohol relaxes the lower esophageal sphincter and irritates the esophagus.
- Lose excess weight. Heartburn and acid reflux are more likely to occur when excess weight puts added pressure on your stomach.
- Raise your bed. Sleeping with your upper body raised 4 to 6 inches (10 to 15 centimeters) may help prevent reflux symptoms. Raising the head of your bed with blocks or sleeping on a foam wedge is more effective than is using extra pillows.
- Relax. When you're under stress, digestion slows, possibly worsening reflux symptoms. Relaxation techniques, such as deep breathing, meditation or yoga, may help.
Many people with frequent heartburn use over-the-counter or alternative therapies for symptom relief. Remember that even natural remedies can have risks and side effects, including potentially serious interactions with prescription medications. Always do careful research and talk with your doctor before trying an alternative therapy.
There are no alternative therapies that have been found specifically to relieve bile reflux or protect against and relieve esophageal inflammation. Some herbal remedies may be helpful, but there is no evidence that they work and some may be harmful. If you decide to start any of these therapies, discuss them with your doctor. They include:
- Chamomile, which has anti-inflammatory properties. Chamomile teas are readily available and have a low risk of side effects.
- Licorice, which is commonly used to soothe inflammation associated with GERD, gastritis, ulcers and other digestive problems. However, licorice contains a chemical called glycyrrhizin (glis-uh-RIE-zin) that's associated with serious health risks, such as high blood pressure and tissue swelling, if used long term. Talk with your doctor before trying this therapy. Prescription preparations are available that don't contain glycyrrhizin.
- Slippery elm, a product of a tree bark and root, may help soothe the digestive tract. Slippery elm can be mixed with water and taken after meals and before bed. Slippery elm may decrease the absorption of prescription medications.
- Marshmallow (Althaea officinalis) is an herb — not the puffy white candy — that has been used for GERD symptom relief. Like slippery elm, marshmallow may cause problems with the absorption of medications.
Preparing for your appointment
Make an appointment with your doctor if you have signs or symptoms common to bile reflux. After your doctor's initial evaluation, you may be referred to a specialist in digestive disorders (gastroenterologist).
Here's some information to help you prepare for your appointment and what to expect from your doctor.
What you can do
- Write down any symptoms you're experiencing and for how long.
- Make a list of your key medical information, including any other conditions for which you're being treated and the names of any medications, vitamins or supplements you're taking.
- Find a family member or friend who can come with you to the appointment, if possible. Someone who accompanies you can help remember what the doctor says.
- Write down questions to ask your doctor. Creating your list of questions in advance can help you make the most of your time with your doctor.
Don't hesitate to ask questions during your appointment. Some questions to ask your doctor include:
- Do I have acid reflux, bile reflux or both?
- What treatment approach do you recommend?
- Are there any side effects associated with these treatments?
- Are there any lifestyle or dietary changes I can make to help reduce or manage my symptoms?
- I have other health conditions. How can I best manage them together?
What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may give you time to go over points you want to spend more time on. You may be asked:
- What are your symptoms?
- How long have you had these symptoms?
- Do your symptoms come and go or stay about the same?
- If your symptoms include pain, where is your pain located?
- Have your signs and symptoms included vomiting?
- Does anything seem to trigger your symptoms, including certain foods or beverages?
- Have you lost weight without trying?
- Have you seen a doctor for these symptoms before?
- What treatments have you tried so far? Has anything helped?
- Have you been diagnosed with any other medical conditions?
- Have you had stomach surgery or had your gallbladder removed?
- What medications are you taking, including prescription and over-the-counter medications, vitamins, herbs and supplements?
- What is your typical daily diet?
- Do you drink alcohol? How much?
- Do you smoke?
Sept. 15, 2017