What is Bile?
Before we understand bile reflux, we must understand what bile is. Bile is a part of the digestive process, a digestive fluid produced in the liver and stored in the gallbladder.1
To aid the digestion process, bile breaks down fats into fatty acids, which can then be absorbed by the body and used. Bile is mainly made up of cholesterol but also contains bile acids/bile salts, bilirubin, water, and body salts such as potassium, sodium, copper, and other metals.2
When you eat a meal containing fats, a signal is sent to the liver to produce bile. The bile then enters the duodenum (the upper part of the small intestine) and waits to break down those fats.1
To help to digest what is consumed, bile and food mix in the duodenum and move through the small intestine.
There is a ring of muscle called the pyloric valve located at the outlet of your stomach, which opens slightly during this process. It releases about 3.75 millilitres of liquefied food at a time but stays closed enough to keep in the digestive juices, so they don’t leak into the stomach.1
What is Bile Reflux?
Bile reflux of the stomach occurs when the pyloric valve doesn’t close properly, meaning bile can leak back into the stomach. This can cause stomach lining inflammation, referred to as bile reflux gastritis.1
Bile reflux of the oesophagus is caused by the malfunction of a different valve, the lower oesophageal sphincter. (1)
When working correctly, this valve separates the oesophagus and the stomach and opens to allow food to pass into the stomach. When it’s not performing right, the bile and stomach acid can wash back into the oesophagus.1
What are the Symptoms of Bile Reflux?
Bile reflux can have many symptoms, including frequent heartburn in your chest and throat, a sour taste in your mouth, upper abdominal pain, vomiting of a greenish-yellow fluid and unintended weight loss. Occasionally, a cough or hoarseness to the voice can be a symptom, too.3
What Causes Bile Reflux?
There can be a few causes of the issue with the pyloric valve that causes bile reflux. Surgery can cause a problem with the valve - in particular, stomach surgery and gallbladder removal surgery.4
Obstruction of the pyloric valve caused by duodenal ulcers or scar tissue can also generate bile reflux and impaired motility of the pyloric valve. This delays the function of the valve and causes a downward flow of bile.4
How is Bile Reflux Diagnosed?
When the bile reflux is contained in the stomach, it is harder to diagnose. It will be confirmed by imaging tests such as an upper endoscopy exam to have a look inside your oesophagus, stomach and upper small intestine. Possibly, they will take tissue samples to test for inflammation, tissue damage and bile during the upper endoscopy exam.4
When the bile reflux has moved to the oesophagus, it is easier to diagnose based on the symptoms it causes. There may be additional tests to ensure it is not confused with acid reflux, which presents with similar symptoms.4
How is Bile Reflux Treated?
Unfortunately, there’s a real limit to things you can do yourself to help bile reflux. Over-the-counter antacids won’t work, and diet changes don’t help with bile reflux. Small things you can do to ease symptoms include raising your head higher at night, losing excess weight and not eating before bed.4
Your healthcare provider can prescribe medications, but it can be a case of trial and error to find one that works for you. Medications for bile reflux are not particularly well studied, so you may have to try a few different ones before finding the right fit.4
If no medication works for you, surgery may be the only option. Diversion surgery is done to direct bile away from the surgery, or anti-reflux surgery can strengthen and reinforce the lower oesophageal sphincter.
The Bottom Line
Unfortunately, there are limited successful treatment options for bile reflux, as it can be an uncomfortable and even painful problem to have. If you think you may have bile reflux, check in with your healthcare provider and get tested, and keep your fingers crossed that it’s a simple(r) case of acid reflux!