In all likelihood, you’re familiar with heartburn and acid reflux. In fact, you may have even had some bad experiences with them. But you’re probably not familiar with bile reflux, even if you’ve had an experience or two. Why? Because it’s often masked by or mistaken as acid reflux.
So let’s take a look at these two disagreeable conditions, and see if we can better understand their differences.
Acid reflux, also commonly referred to as GERD (Gastro Esophageal Reflux Disease), occurs when stomach liquids are able to rise up through the esophagus sphincter into the esophagus (the tube that connects your throat and your stomach). Because of the mixture of digestive components secreted in the stomach, such as hydrochloric acid and pepsin, the sensitive lining of the esophagus can be damaged, causing a burning sensation.
It’s this burning sensation that most people associate with acid reflux. Bile reflux occurs when the digestive fluid produced by your liver (bile) rises up from your small intestine through the pyloric value into your stomach, and then from your stomach into your esophagus. Bile reflux and acid reflux often go hand-in-hand, occurring together, which is why bile reflux is often overlooked. Unlike acid reflux, however, it will often cause stomach pain (gastritis).
As mentioned above, the biggest difference between these two conditions is the stomach inflammation that accompanies bile reflux. This can cause a burning pain not in the esophagus, but in the upper abdomen. You may also find yourself vomiting bile.
The other primary symptoms, unfortunately, are very similar to acid reflux …
Heartburn – increased occurrences of that burning sensation in your chest that can easily be mistaken as a heart attack when the pain is particularly severe.
Nausea – that feeling of unease in your stomach that comes with an urge to throw up. This is one of the more severe symptoms of acid reflux, though more common in bile reflux.
Hoarseness – this is often the result of stomach acid (or bile) rising up into the throat and burning the lining. This is also a severe symptom of acid reflux, though more common in bile reflux sufferers.
Over the long haul, if bile reflux goes undetected or if it’s simply ignored, it can lead to more serious consequences. Again, some of these can also be the result of long-term neglect of an acid reflux condition. In either case, they demonstrate the importance of seeing your doctor when things just aren’t working the way they should.
Here’s some of the big time concerns …
Gastritis – although generally the least serious of these concerns, gastritis (stomach irritation) can lead to bleeding, stomach ulcers, and even the potential of stomach cancer if left untreated. Most of the time, the discomfort of gastritis is such that it inspires a visit to the doctor, so it rarely gets too far out of hand.
Narrowing of The Esophagus – just as long term acid reflux can eventually begin to damage the esophagus lining, creating scar tissue and narrowing the tube, so can bile reflux. This can lead to difficult swallowing and even the potential for choking.
Barrett’s Esophagus – this is a serious condition that results when the lower esophagus is exposed to stomach acid and/or bile over time. What happens is cells in the lining of the esophagus begin to change in order to protect themselves. Unfortunately, while these new cell structures are resistant to stomach acid, they’re also more prone toward malignancy.
Cancer of The Esophagus – while there continues to be some debate about the relationship between bile reflux and cancer of the esophagus; animal studies appear to show a connection. This is a serious form of cancer that often goes undiagnosed until it’s in the advanced stages.
The primary cause behind bile reflux is damage to the pyloric valve. This can occur in several different ways; however it’s most commonly the result of surgery. For instance, one of the side effects of gallbladder surgery can be bile reflux. In addition, it’s not unusual for someone who’s gone through gastric surgery (such as the complete removal of their stomach or a gastric bypass) to develop bile reflux. In all these instances, the condition is a result of damaging the pyloric valve.
A peptic ulcer can also be a contributing factor. This happens when the ulcer obstructs the pyloric valve, restricting its ability to close properly. In rare instances, chronic constipation can also result in bile reflux.
Finally, recent research has demonstrated that the use of proton-pump inhibitors (PPIs) in treating acid reflux actually increased the occurrences of bile reflux. The reason for this result isn’t fully understood, but it does help explain why some people on PPIs don’t appear to show a reduction of their acid reflux episodes.
The unfortunate news about treating bile reflux is that it appears to be completely independent of lifestyle influences. So a diet change or more exercise or tossing out your cigarettes isn’t likely to help. However, with that in mind, bile reflux is often a companion to acid reflux, which does benefit from some lifestyle changes. So you may want to make some changes simply to see if they relieve some of your symptoms.
Here are some changes you might consider …
- Sleep with your head elevated. A wedge pillow can be great for this. When your head is elevated, it helps to keep the stomach acid (and bile) where they belong.
- Eat smaller meals, spread throughout the day. Also, allow at least three hours after eating your last meal before going to bed for the night.
- Drop those extra pounds (doesn’t this one seem to accompany nearly every health condition?). Add weight adds pressure on your stomach, which can force its contents up into the esophagus.
- Avoid those foods that tend to relax the lower esophagus sphincter. These foods include all your favorites: caffeine, chocolate, citrus, carbonated drinks, tomatoes, spicy foods, even peppermint. And if these weren’t enough, limit your fatty foods, including just about anything you stumble across at a fast food restaurant.
- Finally, consider limiting your alcohol intake since it also tends to relax the sphincter than keeps the food and liquids in your stomach where they belong.
Again, these are steps you can take to try to relieve some of the discomfort you’ve been experiencing that may be related to acid reflux. They won’t help alleviate your bile reflux condition. I list them here simply because the two conditions are so often intertwined. Serious Treatments
I mentioned proton pump inhibitors (PPIs) above. These medications (Nexium, Prevacid and AcipHex are good examples) were developed to inhibit acid production, which really isn’t the issue for bile reflux sufferers. However, your doctor may recommend one these simply to reduce your overall reflux symptoms. There is no evidence that they will help with your bile reflux, and as mentioned above, they may actually aggravate the condition.
The other drug that I want to mention here is ursodeoxycholic acid. This is a common prescription for bile reflux, and is often used to dissolve gallstones. For bile reflux, it’s been shown to reduce the intensity of that burning sensation in the stomach. It also eliminates nausea and vomiting. While it doesn’t completely solve the problem, it does tend to dramatically reduce the frequency and severity of bile reflux symptoms.
Finally, in relation to medications, there are several cholesterol-lowering medications, such as Questran and Colestid that can also assist your body in removing bile. For these medications, in fact for all the medications I’ve mentioned here, you really need to sit down and discuss them with your doctor.
The Surgical Option
Surgery. No one wants to hear that word coming out of the mouth of their doctor. However, there are times when surgery becomes the only option. Fundoplication is primarily used for acid reflux. The procedure strengthens the lower esophagus sphincter, which in turn dramatically reduces the rise of acid from the stomach to the esophagus. Since bile is often mixed in with the stomach acid, fundoplication is believed to help minimize some of the effects of bile reflux.
The other surgical procedure is called a Roux-en-Y (roo-en-wi), which is a term used for diversion surgery (this is the same type of procedure as weight loss bypass surgery). The goal of this procedure is to divert bile away from the stomach. The success rate of Roux-en-y surgery can range anywhere from 50%-90%.
While bile reflux isn’t as common nor as well known as acid reflux, it’s often masked by the symptoms they share. The biggest clue that you might be dealing with bile reflux will be a burning sensation that takes place in the upper abdomen. This is a red-flag symptom that should alert you that you may be experiencing something more than just acid reflux, and you need to see your doctor.
This document has not been evaluated by the Food and Drug Administration, and it should not be used to diagnose, treat, cure, or prevent any disease. It is provided here for educational and information purposes only. Please, always consult your doctor or health care specialist if you are in any way concerned about your physical wellbeing.
You don’t have to suffer with bile reflex. There are natural treatment nonsurgical options which will take time to investigate. First you need to treat thee root cause of symptoms, this requires a diagnosis, i.e removing the gallbladder function resulting in continual bile flow including when no food is present. Surgical solution will not meet this requirement and risks and side effect risk claimed as being low are not reflected as being honest in support groups. Seek advise from a holistic doctor first before diving into the surgical option.