Bile reflux occurs when bile, which is released from the gallbladder into the first part of the intestine, flows backward into the stomach or even into the esophagus. This backward flow can irritate and inflame the lining of the stomach.
When this happens, changes may occur in the protective mucus layers of the stomach, along with an increase in gastric pH. These changes can trigger symptoms such as upper abdominal pain, a burning sensation in the chest, and yellowish vomiting.
To relieve symptoms and treat bile reflux, also known as duodenogastric reflux, a gastroenterologist may recommend medications that help reduce discomfort and improve bile circulation. In more severe cases, when symptoms do not improve with medication, surgical treatment may be necessary.
Main symptoms
The main symptoms of bile reflux are:
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Upper abdominal pain
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Burning sensation in the chest
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Nausea
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Green or yellowish vomiting
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Cough or hoarseness
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Weight loss
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Increased risk of bacterial overgrowth
Although these symptoms are very similar to those of gastroesophageal reflux, the two conditions are considered different. For this reason, diagnosis should always be performed by a gastroenterologist.
Confirming a diagnosis
The diagnosis of bile reflux is made by a gastroenterologist based on an evaluation of the person’s symptoms and medical history. To confirm the diagnosis, the doctor may request tests such as endoscopy and esophageal impedance monitoring, which help determine whether bile is refluxing into the esophagus.
Possible causes
Bile reflux occurs when the pyloric sphincter, which separates the stomach from the duodenum, does not function properly. This may happen as a result of complications from gastric surgery, gallbladder surgery, or the presence of stomach ulcers.
Under normal conditions, bile is produced by the liver and stored in the gallbladder. It is released when fats need to be broken down or when worn-out red blood cells and toxic substances must be eliminated, traveling to the duodenum where it mixes with food to support digestion.
After this process, the pyloric valve opens to allow only food to pass forward. However, when the valve does not close properly, bile can flow back into the stomach and esophagus, leading to bile reflux.
Treatment options
Bile reflux can be cured, but treatment may take longer compared to other digestive conditions. For this reason, it is important to carefully follow the gastroenterologist’s recommendations.
Treatment most often involves medications prescribed by a doctor, such as ursodeoxycholic acid, which helps improve bile flow and reduces the frequency and intensity of symptoms. Other medications may also be used, including bile acid sequestrants, which bind to bile acids in the intestine and prevent their reabsorption.
When symptoms do not improve with medication, the gastroenterologist may recommend surgery. In this procedure, known as diversion surgery, the surgeon creates a new pathway for bile to drain further down the small intestine, diverting bile away from the stomach.