Medically reviewed by Onikepe Adegbola, MD, PhD
What is bile? It is a yellow/green fluid produced by the liver and stored in the gallbladder. It helps to digest and dissolve fats in the small intestine. Bile constitutes bilirubin, cholesterol, bile salts, salt, and water.
Typically, bile travels from the gall bladder into the small intestine. However, sometimes this path is interrupted for reasons that can cause bile to enter the stomach. This also relaxes the lower esophageal sphincter, causing bile and acid to back up in the esophagus.
Throwing up bile is not the same as vomiting out stomach contents. Bile reflux, which happens on rare occasions, can be considered normal.
However, different kinds of testing may be required to evaluate pathological bile reflux.
- Endoscopy: A thin camera in a tube is passed down the throat to look for bile, ulcers, and gastric inflammation. It also helps to check the functioning of the esophageal sphincters.
- Ambulatory acid tests: Biochemical analysis of vomited contents is done to look for bile salts. Acid probe tests are done with the aid of a catheter and help rule out acid reflux.
- Esophageal impedance test: This is done to detect non-acidic contents in the esophagus, like bile.
Reasons For Repeated Bile Reflux
Some of the primary causes for repeated incidence of bile reflux are listed below:
- Throwing up on an empty stomach (including morning sickness during pregnancy)
- Excessive drinking of alcohol
- Food poisoning
- Intestinal block; this can happen due to scarring post stomach or pelvic surgery (The research paper “Gastrointestinal complications in the postoperative period” will help understand this better.)
- Cancers or tumors in the pelvis
- Diverticulitis or the formation of pouch-like cavities in the intestines
- Hernia, an abnormal looping of the intestine into the abdominal cavity
- Inflammatory bowel syndrome; inflammation of the small intestine, Crohn’s disease, and ulcerative colitis causing bile duct disorders, large ulcers, deep inflammation, and granuloma formation in the intestine
How To Treat Bile Reflux
Treatment of bile reflux has to be initiated according to what is causing it.
Management of episodic bile reflux
- Bile reflux due to food poisoning: You may need probiotics, medications as prescribed by your doctor, and oral/intravenous electrolytes to help with acid and bile reflux.
- Bile reflux due to excessive drinking: Intravenous electrolytes will be required to flush out the alcohol from the system.
Management of recurrent bile reflux
Medications may be required if bile reflux occurs more often. Some of the medicines used to treat bile reflux are:
- Ursodeoxycholic acid: This changes the chemical composition of bile to help it travel through the intestine more rapidly and efficiently.
Side effects: Diarrhea
- Bile acid sequestrants: These medications change the circulation rate of bile in the body.
Side effects: Gas, bloating
- Sucralfate: This forms an internal film over the stomach and esophagus to protect it from bile reflux.
In cases of recurrent and severe bile reflux, detailed investigations based on symptoms are to be done to determine the causative disease. Surgical intervention may be required to provide long-term relief from symptoms.
- Removal of intestinal obstructions, including benign growths and tissue obstruction.
- Hernia repair surgery
- Gastric bypass surgery helps drain the bile directly into the intestine without entering the stomach
- Surgical excision of the damaged part of the intestine if required
- Placing an inflated stent to help remove any obstructions and dilate the intestine
- Cancers of the intestine have to be treated based on the extent of spread with chemotherapy, radiation, and other surgical options
Preventive Measures/Lifestyle Changes
To reduce the risk of bile reflux, you can:
- Limit alcoholic beverages to a maximum of 2-3 drinks a day
- Screen for colorectal cancer after the age of 50, and eat lots of fruits and vegetables.
- Stop smoking
- Take a high-fiber diet, which can reduce your risk of developing diverticulitis
- Avoid lifting hefty weights or objects to prevent an intestinal hernia
The article titled “Management of bile reflux” can also help you understand how to manage bile reflux.
Talk to your doctor if you experience bile reflux along with:
- Unexplained weight loss
- Chest pain
- Breathing difficulties
- Vomit with coffee grounds appearance
- Continued vomiting
- Extreme abdominal pain associated with vomiting
What Are The Dietary Changes You Can Make To Control Bile Reflux?
- Eating small/ frequent meals will help relieve pressure from the esophageal sphincter and control its abrupt opening.
- Sit upright after meals. Do not lie down for 2-3 hours after your meal to help with stomach emptying.
- Reduce fats in the diet. Foods high in fats relax the pressure on the esophageal sphincter and cause delayed stomach emptying.
- Limit problematic foods that can cause delayed stomach emptying, like caffeine, carbonated drinks, chocolates, citrus foods, vinegar, onions, spices, mint, and tomato-rich foods.
- Try to attain your BMI weight. Excess weight increases pressure on the stomach, which can cause reflux.
- Adopt an inclined sleep position. Keeping your head raised over your body helps with acid and bile reflux. You should avoid using too many pillows for doing this. Instead, a foam wedge under your shoulders or elevating your bed using bricks/wood should be considered.
- Control stress factors. Stress is one of the significant contributors to gastric problems. The study titled “Could stress be making my acid reflux worse,” published in Harvard Women’s Health Watch, describes how stress may worsen your reflux. Opt for different naturopathic options to help manage stress, like yoga, meditation, nature walks, journaling, hiking, etc. You can also consider therapy if your stress levels are out of control.
Many alternative health treatments are available to manage acid and bile reflux. People opt for homeopathy, Ayurveda, and naturopathy due to fewer side effects. Acupressure, acupuncture, and chiropractic treatments are also available to help relieve gastric symptoms. Any therapy should be undertaken after a complete diagnosis of what is causing the bile reflux by your physician.
Bile reflux can be controlled or treated depending on what is causing it. A combination of diet modifications and lifestyle changes can reduce acid and bile reflux. However, it is recommended to consult your doctor immediately if you are throwing up bile regularly.
Adzick, N. S., & Farmer, D. L. (2012). Cysts of the lungs and mediastinum. In Pediatric Surgery (pp. 825–835). Elsevier.
Bile. (n.d.). Medlineplus.Gov. Retrieved June 6, 2022, from https://medlineplus.gov/ency/article/002237.htm
Sifrim, D. (2013). Management of bile reflux. Gastroenterology & Hepatology, 9(3), 179–180.
Watson, S. (2017, June 9). Throwing up bile: Causes, treatments, and complications. Healthline. https://www.healthline.com/health/throwing-up-bile