Bile Reflux

February 1, 2017

Bile Reflux also called duodenogastric reflux, is a condition where the bile – a digestive fluid produced in the liver, flows upward i.e. refluxes from the small intestine towards the stomach and esophagus.

Bile is a digestive fluid produced in the liver. Some of the components that make up bile are –

  • Water
  • Cholesterol
  • Bile pigments
  • Bile salts

Bile is produced by the liver, stored in the gallbladder, and released into the duodenum (the upper section of the small intestine) when needed to aid the digestion of fats. Bile is essential for digesting fats and for eliminating aged red blood cells and certain toxins from the body.

Bile reflux is the result of bile that travels up from the small intestine into the stomach and esophagus. Bile reflux is caused by damage to the pyloric valve, which is a ring of muscle that separates the stomach from the duodenum. When the pyloric valve fails to close properly, bile flows into the stomach, causing pain and inflammation.

BR is sometimes confused with acid reflux because a person can experience some of the same symptoms and bile (like GERD) irritates the lining of the esophagus, potentially increasing the risk of esophageal cancer. The difference is –

  • Acid reflux symptoms are indigestion, heartburn, stomach pain, pain swallowing and esophagus inflammation caused by stomach acids going through the lower esophageal sphincter into the esophagus.
  • Bile reflux symptoms are heartburn, gastritis, hoarseness, chronic cough, pain swallowing, esophagus inflammation caused by bile from the gallbladder making its way through the pyloric valve from the small intestine continuing its way through the lower esophageal sphincter into the esophagus.

Bile reflux causes damage to the lining of the stomach (called gastritis), which may progress to sores in the stomach (known as ulcers), bleeding, and stomach cancer. In patients that have both bile reflux and acid reflux, the combination seems to be particularly harmful, increasing the risk of damage to the esophagus, including conditions such as Barrett’s esophagus and esophageal cancer.

Causes

Bile reflux into the stomach – Bile is secreted in the duodenum and passes down the gut with the rest of the intestinal chyme. If the integrity of the pyloric valve – part of the stomach that controls the outflow of gastric contents into the duodenum, is compromised then the retrograde flow of bile may occur leading to irritation of the stomach lining. This can cause persistent gastritis despite the appropriate gastritis treatment.

Bile reflux into the esophagus – If the lower esophageal sphincter is also impaired, then the bile along with the acidic stomach contents can flow up into the esophagus. Irritation of the mucosal lining by the bile, even if the stomach acid is neutralized by one or more agents discussed under stomach acid medication, will cause the typical symptoms associated with acid reflux.

Most cases of bile reflux are associated with chronic conditions affecting the pyloric sphincter and lower esophageal sphincter (LES).

Risk Factors

Surgery complications – Gastric surgery, including total removal of the stomach (gastrectomy) 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 enough to allow the stomach to empty as quickly as it should. 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 (cholecystectomy) – People who have had their gallbladders removed have significantly more bile reflux than do people who haven’t had this surgery.

Symptoms

  • General – Bile reflux and acid reflux have similar signs and symptoms, and the two conditions may occur at the same time. Unlike acid reflux, bile reflux often causes a burning or gnawing pain in the stomach.
  • Cough or hoarseness – Some, but not all, patients with bile reflux experience a cough or hoarseness that is caused by stomach acid and/or bile rising up into the throat and burning the lining.
  • Frequent heartburn – Heartburn is a burning sensation in the chest that may spread to the throat along with a sour taste in the mouth. In severe cases, it may be mistaken for a heart attack.
  • Nausea and vomiting – Nausea is feeling the need to vomit. Some patients with bile reflux may vomit bile.
  • Upper abdominal pain – Bile reflux often causes a burning or gnawing pain in the stomach.
  • Weight loss – In some patients with bile reflux, unintended weight loss may occur.

Complications

GERD – Occasional heartburn usually isn’t a concern. But frequent or continual heartburn is the most common symptom of GERD, a potentially serious problem that causes irritation and inflammation of esophageal tissue (esophagitis). GERD is most often due to excess acid. Although bile has been implicated, its importance in reflux is controversial.

Barrett’s esophagus – This serious condition can occur 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 have also linked bile reflux to the occurrence of Barrett’s esophagus.

Esophageal cancer – This form of cancer may not be diagnosed until it’s quite advanced. The possible link between bile and acid reflux and esophageal cancer remains controversial, but many experts think a direct connection exists. In animal studies, bile reflux alone has been shown to cause cancer of the esophagus.

Gastritis – In addition to causing irritation and inflammation in the esophagus, bile reflux can cause stomach irritation (gastritis).

Treatment

Medications

  • Ursodeoxycholic acid – This medication helps promote bile flow. It may lessen the frequency and severity of your symptoms.
  • Bile acid sequestrants – Doctors often prescribe bile acid sequestrants, which disrupt the circulation of bile, but studies show that these drugs are less effective than other treatments. Side effects, such as bloating, may be severe.
  • Proton pump inhibitors – These medications are often prescribed to block acid production, but they don’t have a clear role in treating bile reflux.

Surgery

Diversion surgery (Roux-en-Y) – This procedure, which is also a type of weight-loss surgery, recommended for people who have had previous gastric surgery with pylorus removal. In Roux-en-Y, surgeons make a new connection for bile drainage farther down in the small intestine, diverting bile away from the stomach.

Anti-reflux surgery (fundoplication) – The part of the stomach closest to the esophagus (fundus) is wrapped and then sewn around the lower esophageal sphincter. This procedure strengthens the valve and can reduce acid reflux. There is little evidence about the surgery’s effectiveness for bile reflux.

Lifestyle Changes

Limit or avoid alcohol – Drinking alcohol irritates the esophagus and relaxes the lower esophageal sphincter, predisposing the body to acid reflux.

Quit smoking – Smoking increases the production of stomach acid and dries up saliva, which cause the esophagus to be more vulnerable to damage by refluxed bile and stomach acid.

Relaxation – Patients under stress experience slower digestion, which may worsen reflux symptoms.

Tilted bed – Raising the head of the bed by about 4-6 inches may prevent reflux symptoms. Using a wedge or blocks is more effective than using pillows.

Weight loss – Overweight patients with bile reflux may lessen the backflow of bile when less body fat is pressing down on the stomach and small intestine.

Alternative Treatment

Magnesium helps control the muscle function in the digestive tract and throughout the body. It also aids in digestion to alleviate reflux issues.

Dimethyl sulfoxide (DMSO) is naturally found in vegetables, fruits, grains, and animal products. DMSO is available for both nonmedicinal and medicinal uses. The major clinical use of DMSO is to relieve symptoms of interstitial cystitis (chronic bladder infection).

A multivitamin daily, containing the antioxidant vitamins A, C, E, the B vitamins, and trace minerals, such as magnesium, calcium, zinc, and selenium.

Gamma-oryzanol occurs in rice bran oil and has been extracted from corn and barley oils as well. Gamma-oryzanol is frequently sold as a body-building aid, specifically to increase testosterone levels, stimulate the release of endorphins (pain-relieving substances made in the body), and promote the growth of lean muscle tissue.

Omega-3 fatty acids, such as fish oil, may help decrease inflammation. Omega-3 fatty acids may increase the risk of bleeding, as ask your doctor before taking omega-3 fatty acids if you take blood-thinning medications.

Qi gong, an ancient type of traditional Chinese medicine (TCM) consisting of choreographed movements, postures, and meditation, has been used for thousands of years. It is traditionally used for spiritual enlightenment, medical care, and self-defense. Qi gong is meant to be in balance with the environment and has been described as “a way of working with life energy.”

Probiotics or “friendly” bacteria may help maintain a balance in the digestive system between good and harmful bacteria.

Chamomile, which has anti-inflammatory properties. Chamomile teas are readily available and have a low risk of side effects.

Licorice, which is commonly used to soothe inflammation associated with GERD, gastritis, ulcers and other digestive problems. However, licorice contains a phytochemical called glycyrrhizin that’s associated with serious health risks — such as high blood pressure and tissue swelling — if used long term. Talk with your doctor before trying this therapy. Prescription preparations are available that don’t contain glycyrrhizin.

Slippery elm, which encourages a protective mucous lining. Available as a root bark powder, slippery elm can be mixed with water and taken after meals and before bed. It may, however, decrease the absorption of prescription medications.

Marshmallow (Althea officinalis), which has been used for GERD symptom relief. Like slippery elm, marshmallow may cause problems with the absorption of medications. Note that this is the herb, not the puffy white confection.

Thymus extracts for nutritional supplements are usually bovine (derived from young calves). Thymus extract is commonly used to stimulate the immune system and to treat bone marrow failure, autoimmune disorders, chronic skin diseases, recurrent viral and bacterial infections, hepatitis, allergies, chemotherapy side effects, and cancer.

Garlic – The garlic bulb is made of many cloves wrapped with a paper-thin, white skin, and it is used both medicinally and as a spice in food (fresh or dehydrated). Garlic is widely used for the treatment and prevention of cardiovascular disease and cancer.

 

Reference –

http://www.thewhimsicalist.com/food/acid-reflux-bile-reflux-elimination-diet/

http://www.americanjournalofsurgery.com/article/S0002-9610(03)00213-7/abstract

http://www.healthblurbs.com/causes-for-biliary-bile-duct-cholecystitis-cancer-cirrhosis-sclerosing-cholangitis-bile-reflux-symptoms/

http://www.boldsky.com/health/disorders-cure/2013/bile-reflux-cure-ten-lifestyle-changes-034975.html

https://www.aapc.com/memberarea/forums/gastroenterology/5089-dx-code-bile-reflux-acid-refllux.html

http://www.streetdirectory.com/travel_guide/113021/medical_conditions/what_is_bile_reflux.html

http://www.healthhype.com/bile-reflux-symptoms-causes-treatment-medication-surgery.html

http://www.earthclinic.com/cures/bilary-reflux.html

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