Bile reflux occurs when bile â a digestive liquid produced in your liver â backs up (refluxes) into your stomach and the tube that connects your mouth and stomach (esophagus).
Bile reflux may accompany acid reflux, the medical term for the backwash of stomach acids into your esophagus. However, bile acid reflux and acid reflux are separate conditions.
Whether bile is important in reflux is controversial. Bile is often a suspected cause of reflux when people respond incompletely or not at all to powerful acid-suppressant medications. But there is little evidence pinpointing the effects of bile reflux in people.
Unlike acid reflux, bile reflux usually can't be completely controlled by changes in diet or lifestyle. Treatment involves medications or, in severe cases, surgery.
Bile reflux can be difficult to distinguish from acid reflux. The signs and symptoms are similar, and the two conditions may occur at the same time. It isn't clear what role bile plays in reflux conditions.
Bile reflux signs and symptoms include:
Make an appointment with your doctor if you frequently experience symptoms of reflux, or if you're losing weight without trying.
If you've been diagnosed with gastroesophageal reflux disease (GERD) but aren't getting adequate relief from your medications, call your doctor. You may need additional treatment for bile reflux.
Bile is a greenish-yellow fluid that is essential for digesting fats and for eliminating worn-out red blood cells and certain toxins from your body. Bile is produced in your liver and stored in your gallbladder.
Eating a meal that contains even a small amount of fat signals your gallbladder to release bile, which flows through two small tubes (cystic duct and common bile duct) into the upper part of your small intestine (duodenum).
Bile and food mix in the duodenum and enter your small intestine through the pyloric valve, a heavy ring of muscle located at the outlet of your stomach. The pyloric valve usually opens only slightly â enough to release about an eighth of an ounce (about 3.5 milliliters) of liquefied food at a time, but not enough to allow digestive juices to reflux into the stomach. In many cases of bile reflux, the valve doesn't close properly, and bile washes back into the stomach.
Bile and stomach acid can reflux into the esophagus when another muscular valve, the lower esophageal sphincter, malfunctions. The lower esophageal sphincter separates the esophagus and stomach. The valve normally opens just long enough to allow food to pass into the stomach. But if the valve weakens or relaxes abnormally, bile can wash back into the esophagus.
Bile reflux may be caused by:
A description of your symptoms is often enough for your doctor to diagnose a reflux problem. But distinguishing between acid reflux and bile reflux is difficult and requires further testing. You're also likely to have tests to check for damage to your esophagus and stomach, as well as for precancerous changes.
Tests may include:
Ambulatory acid tests. These tests use an acid-measuring probe to identify when, and for how long, acid refluxes into your esophagus.
In one test, a thin, flexible tube (catheter) with a probe at the end is threaded through your nose into your esophagus.
In another (the Bravo test), the probe is attached to the lower portion of your esophagus during endoscopy. Ambulatory acid tests can help your doctor rule out acid reflux but not bile reflux.
Sticky mucus coats and protects the lining of your stomach from the corrosive effects of stomach acid. The esophagus lacks this protection, so acid and bile reflux can seriously damage esophageal tissue. The combination of bile and acid reflux increases the risk of complications, including:
Many people with frequent heartburn use over-the-counter or alternative therapies for symptom relief. Remember that even natural remedies can have risks and side effects, including potentially serious interactions with prescription medications. Always do careful research and talk with your doctor before trying an alternative therapy.
There are no alternative therapies that have been found specifically to relieve bile reflux or protect against and relieve esophageal inflammation. Some herbal remedies may be helpful, but there is no evidence that they work and some may be harmful. If you decide to start any of these therapies, discuss them with your doctor. They include:
Unlike acid reflux, bile reflux seems unrelated to lifestyle factors. But because many people experience both acid reflux and bile reflux, your symptoms may be eased by lifestyle changes: