Overview
Bile reflux happens when bile backs up into the stomach. Bile is a liquid the liver makes to help digest food. Sometimes, this liquid then backs up into the esophagus, the tube that connects the mouth and stomach. Bile reflux may happen due to an incompetent sphincter between the stomach and the small intestine, known as the pylorus. It also may happen after certain surgeries, including weight-loss procedures or gallbladder surgery.
Bile reflux is different from acid reflux, also known as gastroesophageal reflux disease or GERD, when stomach acid backs up into the esophagus. It's possible to have both bile and acid reflux.
Unlike with acid reflux, changes in diet and lifestyle don't completely relieve bile reflux. Medicines are used to treat bile reflux. In rare cases, surgery may be needed.
Bile reflux
Bile is a digestive fluid produced by the liver and stored in the gallbladder. During bile reflux, digestive fluid backs up into the stomach and, in some cases, the esophagus.
Symptoms
Bile reflux can be difficult to tell from acid reflux. The symptoms are alike, and the two conditions may happen at the same time.
Bile reflux symptoms include:
- Upper belly 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 bile, a fluid with a greenish-yellow color.
- Loss of appetite.
When to see a doctor
Make an appointment with a healthcare professional if you often have symptoms of reflux, or if you're losing weight without trying.
If you've been diagnosed with acid reflux or gastroesophageal reflux disease (GERD) but aren't getting enough relief from your medicines, call your healthcare team. You may need additional treatment for bile reflux.
Causes
Bile is needed for digesting fats and for getting rid of worn-out red blood cells and certain toxins from your body. Bile is made 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. The bile then flows through a small tube into the upper part of your small intestine, known as the duodenum.
Bile reflux into the stomach
Bile and food mix in the duodenum and enter the small intestine. The pyloric valve, a heavy ring of muscle located at the outlet of the 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. However, it doesn't open wide 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, called 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 typically opens just long enough to allow food to pass into the stomach. But if the valve weakens or relaxes too much, 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.
Risk factors
Risk factors for bile reflux include:
- Diabetes. Long-standing diabetes with unregulated blood sugar can affect the function of a nerve that helps move food through the intestine, called the vagus nerve.
- Obesity. Research shows an association between bile reflux and having a body mass index (BMI) over 30.
- Gallbladder disease. People who have gallbladder conditions, such as gallstones or polyps, are at increased risk of bile reflux.
- Smoking and alcohol abuse. Smoking or drinking too much alcohol can irritate the intestinal lining as well as loosen the pyloric valve.
- H. pylori infection. Some researchers believe Helicobacter pylori (H. pylori) infection of the stomach is associated with bile reflux. However, this is still being debated.
Complications
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 medicines.
- Barrett esophagus. This serious condition can happen 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 also have 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.
Bile reflux gastritis has been linked to stomach cancer.