Bile reflux occurs when bile, a liquid that the liver makes, flows back up into the stomach or the esophagus. It may be a sign of an underlying condition or a complication of certain surgical procedures.

Bile helps the intestines digest food. Bile reflux can happen for many different reasons. Underlying medical conditions such as an atypical formation in the stomach or intestines can cause it. Bile reflux can also occur as a side effect of certain surgical treatments, for example, gastric or gallbladder surgery.

This article reviews bile reflux, including symptoms, what causes it, and how doctors diagnose and treat the condition. It also discusses how a person may prevent bile reflux.

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Bile reflux occurs when bile in the small intestine flows back into the stomach or, in some cases, to the esophagus.

When one of the valves, or sphincters, that usually prevent digestive fluids from going in the wrong direction is not functioning properly, it can cause bile reflux. Bile ends up in places in the body it should not be.

Bile reflux tends to be uncommon in people who do not have any health problems, but it is a well-known complication of certain surgeries. It can cause several symptoms, including severe abdominal pain. Over time, the inflammation associated with the condition can lead to several complications.

Bile reflux differs from acid reflux, which occurs when the gastric acids flow back into the esophagus. However, a person can experience both at the same time.

Bile reflux can cause several symptoms, some of which are in common with many other conditions involving the gastrointestinal (GI) system, such as acid reflux.

The symptoms of bile reflux may include:

How long does bile reflux last?

The duration of bile reflux can vary.

After its first occurrence, some people may experience it several times a week. Bile reflux may reoccur until a person receives appropriate treatment.

Bile reflux causes symptoms similar to other GI conditions, in particular, acid reflux, so a doctor may not be able to identify which one a person has without testing.

An individual should speak to a doctor if they experience GI symptoms that do not improve with diet and lifestyle changes or if over-the-counter (OTC) acid reflux medications do not provide relief. However, bile reflux does not usually improve with any of these measures alone.

Bile reflux can happen for the following reasons:

  • as a complication of surgery, such as bariatric or gallbladder surgery
  • due to a structural problem with an esophageal valve, which allows the food and bile to flow back up into the esophagus
  • due to a problem with the function of the gastric valve called the pyloric valve, which may occur due to peptic ulcers

Doctors can usually identify the cause after a series of diagnostic tests.

Diagnosis of bile reflux usually requires a combination of exams, which can include:

  • a test using the Bilitec monitoring system to detect the presence of bile and its color
  • a hepatobiliary iminodiacetic acid (HIDA) scan to assess the status of the liver, gallbladder, and bile ducts
  • an upper endoscopy to check the esophagus, stomach, and the upper section of the small intestine for any atypical formations
  • other tests, such as esophageal impendence or pH tests, to help rule out acid reflux

Bile reflux does not usually improve with diet or lifestyle changes.

Medications

Doctors may recommend medications for mild bile reflux. These may include:

  • bile acid sequestrants to disrupt the circulation of bile, such as:
    • cholestyramine (Prevalite)
    • colestipol (Colestid)
    • colesevelam (Welchol)
  • sucralfate (Carafate), which creates a protective lining in the stomach and treats peptic ulcers that may be causing the reflux
  • ursodiol (Actigall) to treat disorders of the liver or bile ducts that may be the root cause of the reflux

For more severe bile reflux or when medications have not been effective, doctors may advise surgery. This might correct any atypical malformation in the GI system or fix any issues due to other surgical procedures.

Surgery can also help prevent long-term consequences.

Surgery

Interventions can include diversion or anti-reflux surgery.

With diversion surgery, the specialist creates a new connection for bile drainage further down in the small intestine. This prevents reflux from entering the stomach.

Anti-reflux surgery involves sewing a part of the stomach’s lining around the lower esophageal sphincter, which controls the movement of substances in the esophagus. However, there is not enough evidence to confirm this is an effective option.

Making the following changes can help prevent bile from flowing back into the esophagus:

  • losing excess weight
  • avoiding lying down for 3 hours after eating
  • limiting high fat foods
  • avoiding eating big food portions at mealtimes
  • avoiding caffeine and peppermint

Bile reflux presents symptoms similar to other GI tract conditions, including acid reflux. While bile reflux is not common, it can occur due to atypical formation or function of certain valves in the GI system. It can also occur as a complication of bariatric or gallbladder surgery.

Bile reflux usually requires medications and, sometimes, surgery. If left untreated, bile reflux can irritate the GI tract and increase the risk of complications.