Stomach Bile Acid Reflux – Causes, Symptoms and Treatment

Also known as gall, bile is a dark green or yellowish fluid that is synthesized in the liver. The bile is then transported to the gallbladder, where it is stored. Bile plays a role in the process of digestion. When fatty foods enter the small intestine, the bile from the gallbladder is released into the duodenum (the first part of the small intestine). In the intestinal lumen, the bile helps in the emulsification of fats, a process that aids with the digestion of fatty foods.

In addition, the liver also eliminates metabolic wastes through the bile, which gets passed out of the body through the stool. The passage of bile is normally a one way process. The bile flows from the liver to the gallbladder, from where it is secreted into the duodenum. The bile then passes down the intestine and is expelled along with the stool.

Restriction of bile entry into the stomach

The duodenum is connected to the terminal part of the stomach. The unidirectional flow of material through the stomach is made possible by the presence of two valves at either end of the stomach. These two one-way valves are known as the lower esophageal sphincter (abbreviated as LES) and the pyloric sphincter. The lower esophageal sphincter lies at the junction of the esophagus and the stomach.

This valve allows the entry of food from the esophagus into the stomach, but does not allow a flow of stomach contents back into the esophagus. The pyloric sphincter lies at the junction of the stomach and the duodenum. This valve allows the movement of stomach contents into the duodenum, but prevents backward flow of the intestinal contents into the stomach.

Causes of Bile in the Stomach

As mentioned above, the flow of bile is normally unidirectional. The valves present in the stomach prevent a backward flow of the intestinal contents, including bile. However, under conditions where these valves become faulty, a backward flow of bile into the stomach is possible. Such an event is known as bile reflux.

Depending on the extent of damage to the valves, bile reflux may result in the bile reaching as far back as the esophagus, pharynx, and even the mouth. Bile reflux could be a chronic problem in people with a weakened pyloric sphincter.

It is important to mention that bile reflux into the stomach may occur even when the pyloric sphincter is functioning properly. This is the case during forceful and severe vomiting. Bile acid reflux is different from gastroesophageal reflux disease (commonly abbreviated as GERD).

Read more on GERD.

Gastroesophageal reflux disease, which is characterized by a backward flow of the stomach acid into the esophagus, can occur at any age. Bile reflux is common among adults with the following conditions:

  • Stomach surgery: Bile reflux is common after stomach surgery. Bile reflux is most likely to occur in people who undergo stomach surgery for the removal of stomach cancer, or a gastric bypass surgery in order to lose weight.
  • Gallbladder surgery: Gallbladder surgery, also referred to as cholecystectomy, is an operation to remove the gallbladder. Gallbladder surgery is mostly done for the treatment of gallstones, and is a common cause of bile reflux.
  • Peptic ulcers: The ulcers present in the stomach in peptic ulcer disease may prevent proper emptying of the stomach contents, leading to an increase in the pressure within the stomach. This can cause malfunction of the pyloric valve, leading to backward flow of bile into the stomach.

Signs and Symptoms

Bile reflux is also accompanied by acid reflux from the stomach. Therefore, the signs and symptoms of both bile reflux and acid reflux are similar. The following are some of the signs and symptoms that may signal a bile reflux:

  • Heartburn: A burning sensation in the chest or throat is a symptom of acid reflux, which may be accompanied by bile reflux.
  • Pain in the abdomen: A dull pain may be felt in the upper abdominal region.
  • Nausea and vomiting: Nausea and vomiting may occur due to irritation of the esophagus and the stomach. The presence of bile in the vomitus imparts it a bright yellow or greenish color.
  • Sore throat: Sore throat may be caused by the action of acid and bile on the throat. This usually results in a burning sensation in the throat.
  • Hoarseness of voice: The vocal cords may be affected if the bile enters the larynx. This causes hoarseness of voice.
  • Coughing: Throat irritation caused by bile and stomach acid during reflux can result in coughing.

Read more on bile vomiting.

The above mentioned signs and symptoms are not specific to bile reflux. Some other serious conditions may also present with similar signs and symptoms. Examples include stomach cancer and heart attack. Both stomach cancer and bile reflux may present with unintentional weight loss, in addition to the above mentioned signs and symptoms.

Also, the signs and symptoms of heart attack may be very similar to that of bile reflux and acid reflux. If dizziness, pain in the arm, profuse sweating and shortness of breath occur along with the signs and symptoms mentioned above, a heart attack rather than bile reflux may be the cause.

Untreated and severe cases of bile reflux may lead to serious complications. For example, repeated exposure of esophageal tissue to bile and stomach acid may lead to Barrett’s esophagus and esophageal cancer.

Treatment of Stomach Bile

Treatment of bile reflux is similar to the treatment of acid reflux. Proton pump inhibitors, which are drugs that prevent acid production in the stomach, are also used for the treatment of bile reflux. Bile acid sequestrants (such as cholestyramine, colesevelam, and cholestipol) may also be used.

Surgical treatment may become necessary in cases where bile reflux is severe and persistent. Examples of surgical treatment include Roux-En-Y (or diversion surgery) and fundoplication (or anti-reflux surgery). In diversion surgery, the drainage of bile is diverted through the lower part of the small intestine in order to prevent a reflux into the stomach. In anti-reflux surgery, the lower esophageal sphincter is fortified to prevent acid and bile reflux.

Prevention of bile entry into the stomach

The following are some of the steps that may help in management of bile reflux:

  • Not lying down immediately after a meal.
  • Taking frequent small meals throughout the day.
  • Avoiding alcohol.
  • Maintaining a healthy body weight.

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