Bile Reflux: Symptoms, Causes, and Effective Treatment Options

What is Bile Reflux?

Your liver produces bile, which is stored in your gallbladder and released in limited quantities into your small intestine to help digest food fats, in particular. In bile reflux, the bile doesn’t stay in the duodenum (the first part of the small intestine); instead, it flows into the organs to which it does not belong, such as the stomach and possibly the oesophagus (the food pipe). 

This will cause irritation, damage to the lining of your stomach and oesophagus, inflammation and other digestive problems.

Symptoms of Bile Reflux

The symptoms of bile reflux can be similar to those of acid reflux, such as heartburn, belching, and sour taste in the mouth. These conditions are very difficult to differentiate unless your doctor tests the contents of the regurgitation. 

If you have been treated for acid reflux and find little to no relief with the medications, there is a chance you have bile reflux, and further tests need to be carried out to confirm the diagnosis.

1. Heartburn

Heartburn is a common symptom of bile reflux, which is felt as a burning or gnawing pain in the upper part of your abdomen. It is similar to the heartburn caused by acid reflux, the difference being that bile reflux heartburn does not respond to antacid medications.

What to Look For:

• Burning sensation in your chest, which may spread to your throat.
• Symptoms worsen when you lie down.
• Persists or worsens despite taking antacids.

2. Regurgitation

Bile reflux can result in the regurgitation of bile and partially digested food into the oesophagus or even the mouth. Unlike acid reflux, the content of bile reflux is associated with an alkaline pH, which results in a bitter or sour taste in the mouth.

What to Look For:

• Bitter or sour taste in the mouth.
• Persistent irritation in the throat.
• A feeling of sour fluid coming back up into your mouth.

3. Nausea and Vomiting

When you consume oily or greasy foods, the gallbladder releases bile into the small intestine. In bile reflux, this bile, along with the undigested food particles, moves upward, irritates the lining of your stomach and oesophagus, and results in nausea and vomiting.

What to Look For:

• Digestive discomfort or a sudden feeling of fullness in the upper abdomen.
• A persistent nauseous feeling after eating.
• Vomiting a greenish-yellow fluid (bile).

4. Stomach Pain and Bloating

Bile does not belong in the stomach or oesophagus, and its presence can significantly irritate and damage the lining of these organs, causing inflammation and tissue damage. Abdominal pain and bloating become more pronounced, specifically after a high-fat meal, as fats or oils stimulate the gallbladder to secrete bile. 

What to Look For: 

• Discomfort from fullness after eating only a small quantity of food. 
• Upper abdominal pain. 
• Symptoms worsen after eating fatty/oily food.

5. Coughing or Hoarseness 

Bile is a strong enzyme in the digestive process. When bile reflux travels up the oesophagus, it can even reach the throat and irritate the very sensitive tissues in the throat. This causes soreness and irritation in the throat, a chronic cough, and a hoarse or raspy voice. 

What to Look For: 

• Cough, which is unresponsive to most over-the-counter cough syrups and gets worse when lying down at night. 
• An irritated throat and hoarseness of voice. 
• Sore throat without a specific accompanying cause (like a cold or flu) and no other major symptoms, like fever and runny nose. 

6. Difficulty Swallowing 

In more serious and long-term cases of bile reflux, the constant trauma and irritation from the reflux can eventually lead to damage and inflammation to the degree that it causes scar tissue development. This scar tissue can lead to the narrowing of the oesophagus, causing discomfort, pain, or difficulty swallowing (dysphagia). 

What to Look For: 

• A feeling like food is stuck in the throat or chest. 
• Discomfort or pain when swallowing food. 
• Constantly choking on food and drinks.

Causes of Bile Reflux 

Just as valves control the flow of water through pipes, our digestive system has valves to prevent the contents from backing up. 

Bile reflux is most commonly the result of a problem with the pyloric valve (a ring-shaped muscle found at the bottom of your stomach) controlling the movement of partially digested food from the stomach to the duodenum (the first part of your small intestine). 

Bile reflux can also be caused by a number of issues that affect your bile flow, and the following are the most frequent causes: 

1. Surgical Removal of the Gallbladder (Cholecystectomy) 

For people who have had their gallbladder removed, there is no storage organ for bile. This leaves the bile produced by the liver to drip straight into the small intestine. This can possibly backflow into the stomach. 

2. Peptic Ulcers 

Ulceration of the stomach or small intestine, especially on the pyloric valve, causes inflammation and scarring, which can potentially stop it from opening and closing properly, allowing bile to backflow into the stomach or oesophagus.

3. Gastric Surgery 

Certain surgical procedures, including gastric bypass weight loss surgery or total or partial removal of the stomach, can compromise the integrity of the digestive system and the normal flow of bile, which may result in bile reflux. 

4. Delayed Stomach Emptying 

Delayed stomach emptying, or gastroparesis, is a condition in which the stomach takes too much time to empty its contents, causing food to stay in the stomach longer than usual, thereby increasing the pressure in the abdominal cavity, resulting in the relaxation of the pyloric valve and the reflux of bile into the stomach. 

5. Lower Oesophageal Sphincter (LES) Dysfunction 

The lower oesophageal sphincter (LES) is a ring of muscle located at the end of the oesophagus to prevent the contents of the stomach from coming up into the oesophagus. If this muscle is weak or relaxes when it shouldn’t, bile can travel upwards into the oesophagus. 

6. Overproduction of Bile 

Overproduction of bile may come from a situation of chronic liver disease, cirrhosis or any number of other conditions involving the liver. This will lead to excess bile in the digestive system, which could potentially lead to reflux into the oesophagus or backflow into the stomach.

Effective Treatment Options for Bile Reflux

How can you manage bile reflux? 

A combination of lifestyle and dietary adjustments, medications, and, in some cases, surgery can help manage this condition effectively, allowing you to lead a comfortable and symptom-free life.

1. Medications

Healthcare providers use a variety of medications to treat bile reflux, such as:

Bile Acid Sequestrants:

• This group of medications, such as cholestyramine and colesevelam, bind to bile acids in the intestine to form an insoluble complex that is excreted through faeces. This reduces the amount of free bile acids in your digestive system and reduces their effect on the stomach and oesophagus.

Proton Pump Inhibitors (PPIs):

• Proton pump inhibitors, such as omeprazole and pantoprazole, which effectively reduce the production of gastric acid, are often used to control bile reflux. Practically, however, there are really very few studies to verify the results of PPIS on bile acids.

H2 Blockers:

H2 blockers also work by reducing stomach acid production and may help relieve symptoms of bile reflux associated with acid reflux. It is mainly used to treat GERD, as well as ulcers of the stomach and duodenum.

2. Lifestyle Modifications 

Here are some tweaks to improve your symptoms and get relief from bile reflux: 

Eat Smaller Meals More Often: 

• This can avoid excess pressure inside the abdomen and strain on the digestive system. It also leads to bile being released in small, controlled amounts rather than a large dump, thereby reducing the chances of bile reflux.

Steer Clear of Foods That Make You Feel Worse: 

• Reduce your intake of greasy, fried, and spicy foods, as they can all contribute to increased bile reflux. In addition, be mindful of your consumption of citrus fruits, caffeine, and chocolate, as they might exacerbate your symptoms.

Maintain a Healthy Weight: 

• Increased weight puts pressure on your abdomen, which may weaken the lower oesophageal sphincter (LES) and pyloric sphincter. This can heighten the risk of acid and bile reflux.

Elevate the Head Side of Your Bed: 

• Keeping the head side of your bed elevated during sleep can help prevent bile from refluxing back into your oesophagus and stomach.

Quit Smoking: 

• Smoking weakens the lower oesophageal sphincter, increasing the risk of bile moving up into the oesophagus and throat. 

3. Surgery 

To correct severe cases of bile reflux, you may require surgeries, such as: 

Fundoplication: 

• This surgery is usually recommended for people with severe acid reflux, but may be effective for those with bile reflux as well. Fundoplication involves recreating the lower oesophageal sphincter pressure by wrapping the upper part of the stomach (fundus) around the oesophagus.

Bile Diversion: 

• Bile diversion surgery involves making a new outlet for the drainage of bile further down the small intestine. This allows bile to divert and be away from the stomach, thus reducing the chances of bile reaching the stomach.

The Bottom Line

Bile reflux is more than just discomfort; it can damage the delicate lining tissues of your stomach and oesophagus, which can lead to complications if left untreated. 

What is the answer to addressing bile reflux? Awareness. Knowing its symptoms, understanding its causes, and exploring treatment options can empower you to take action before the damage becomes severe. 

Bile reflux can occur independently or along with acid reflux. The only way to tell them apart is by testing the regurgitate for bile. That’s why it’s dangerous not to address chronic symptoms, including heartburn, regurgitation, nausea, cough, and even hoarseness. 

Don’t wait - just see a health professional for the correct diagnosis and treatment. The sooner you act, the better your chance of keeping your digestive-related symptoms at bay!