Medically reviewed by Onikepe Adegbola, MD, PhD
Bile is an aqueous secretion produced by the liver that consists of water, electrolytes, conjugated bilirubin, cholesterol, phospholipids, enzymes, vitamins, amino acids, and bile salts. Around 500 to 600 mL of this yellow-green-colored secretion is released by the liver’s parenchymal cells, also called hepatocytes, each day. It is stored in the gallbladder in a concentrated form and discharged during digestion.
The formation of bile and its adequate circulation is one of the essential functions in the body because it helps in toxin elimination, cholesterol elimination, growth, metabolism, digestion, combatting liver diseases, etc. Despite having such health-promoting qualities, bile reflux can cause a lot of discomfort and harm to the body.
Understanding Bile Reflux, Its Causes, And Effects
The article titled “Management of Bile Reflux,” published in Gastroenterology & Hepatology defines bile reflux as a condition in which bile along with the components like pancreatic secretion, gallbladder contents, liver secretions, and duodenal fluid are pushed back into the stomach and the esophagus (tube connecting your stomach and mouth).
One study titled “Bile reflux gastropathy: Prevalence and risk factors after therapeutic biliary interventions: A retrospective cohort study,” published in Annals of Medicine and Surgery, mentions that bile reflux occurs due to biliary surgeries or gastric surgeries. These surgeries tend to damage or block the pyloric sphincter (muscle connecting the small intestine and stomach). This study also suggests that bile reflux occurs more in people who have diabetes or are obese.
Yet another study titled “New causes for the old problem of bile reflux gastritis,” published in Clinical Gastroenterology and Hepatology, highlights other causes of bile reflux. According to it, bile reflux does not just occur due to surgical complications but also when the gallbladder malfunctions or cannot act as a reservoir for bile. Further, if dysmotility (a condition wherein muscles in the stomach or intestine become impaired) occurs in the duodenum or the stomach, that may also lead to bile reflux. This study also mentions that symptoms of bile reflux vary and are vague too. However, most people suffer from heartburn, nausea, and dyspepsia (discomfort in the upper abdomen).
According to a study titled “Bile Reflux Gastritis,” published in Southern Medical Journal, bile reflux is also characterized by symptoms such as weight loss, vomiting, and abdominal pain. Another research, “The relationship between gastric cancer, its precancerous lesions, and bile reflux: A retrospective study,” published in the Journal of Digestive Diseases, tried to study the relationship between bile reflux and gastric cancer. It revealed that bile reflux is closely associated with the development of carcinoma (cancer in cells), intestinal metaplasia (cell transformation in the digestive tract), ulcers, and inflammation of the upper gastrointestinal tract.
Is Bile Reflux Different From Acid Reflux?
A journal article titled “Gastroesophageal Reflux Disease (GERD),” published in Missouri Medicine, states that acid reflux occurs when the stomach’s contents enter the esophagus. It is caused due to eating acidic food items, low amounts of exercise, depression, anxiety, smoking, and older age.
One of the studies mentioned above states that distinguishing between acid and bile reflux is not easy because the symptoms associated with both are highly similar. It also indicates that individuals can also experience a combination of acid and bile reflux. This happens because those who suffer from bile reflux tend to have acid reflux. Another reason provided in the study for this is that the gastric-bile secretion is abnormally collected in the center of the stomach causing acid reflux. The same study also explored that bile reflux is often confused with non-acidic reflux. It mentions that bile may or may not be present in the non-acidic reflux contents. In general, one can associate bile reflux with gastric acid contents and not non-acidic contents.
How To Manage Bile Reflux?
There are non-medical, medical, and surgical ways of managing bile reflux. The “Management of Bile Reflux” discussed above also reflects on the following non-medical ways in which bile reflux can be treated:
- Modifications in lifestyle
- Not eating right before sleeping hours
- Not being in supine(lying face upwards) posture after meals
- Avoiding smoking
- Do not consume fatty foods
- Avoiding alcohol
Medical ways to manage bile reflux that are also applicable for treating acid reflux:
- Consumption of prokinetic drugs that help improve the motility of the digestive tract
- Using the Proton Pump Inhibitor (PPI) therapy to combat acid production in the stomach
- Consumption of baclofen that helps reduce reflux episodes and symptoms
Yet another study mentioned earlier, “New causes for the old problem of bile reflux gastritis,” suggests surgical ways of treating bile reflux. It notes that surgical procedures are mainly aimed at diverting the bile and ensuring it does not enter the stomach. Surgical options are advised for people who suffer from severe symptoms of bile reflux and those patients who have previously undergone gastric/biliary surgeries which are causing bile reflux in their body. However, the study warns against further complications of these surgical treatments, which can be caused due to bezoar(ball of swallowed foreign material) formation, ulcers, and roux syndrome.
Despite the existence of non-medical, medical, and surgical ways to manage bile reflux, consulting a proper physician for bile reflux for the right approach is always advised.
Conclusion
Bile reflux happens when the digestive fluid from the intestine moves to the stomach and reaches up to the esophagus. It is often accompanied by acid reflux, which makes the symptoms associated with bile reflux highly dangerous for human health. Diagnosis of bile reflux is difficult as the symptoms are very similar to acid reflux like heartburn, abdominal pain, nausea, vomiting, weight loss, etc. Further, treatment approaches to both bile and acid reflux also appear similar. This is precisely why bile and acid reflux are sometimes confused with being the same condition. However, they should not be considered the same medical condition. Managing bile reflux through non-medical ways might work for many, but medical and surgical options should be explored if things get out of hand.
References
Bondurant, F. J., Maull, K. I., Nelson, H. S., Jr, & Silver, S. H. (1987). Bile reflux gastritis. Southern medical journal, 80(2), 161–165. https://doi.org/10.1097/00007611-198702000-00005
Boyer J. L. (2013). Bile formation and secretion. Comprehensive Physiology, 3(3), 1035–1078. https://doi.org/10.1002/cphy.c120027
Clarrett, D. M., & Hachem, C. (2018). Gastroesophageal Reflux Disease (GERD). Missouri medicine, 115(3), 214–218.
Hofmann, A. F. (2007). Biliary secretion and excretion in health and disease: Current concepts. Annals of Hepatology, 6(1), 15–27. https://doi.org/10.1016/s1665-2681(19)31949-0
Hundt, M., Basit, H., & John, S. (2021). Physiology, Bile Secretion. In StatPearls. StatPearls Publishing.
Li, D., Zhang, J., Yao, W. Z., Zhang, D. L., Feng, C. C., He, Q., Lv, H. H., Cao, Y. P., Wang, J., Qi, Y., Wu, S. R., Wang, N., Zhao, J., & Shi, Y. Q. (2020). The relationship between gastric cancer, its precancerous lesions, and bile reflux: A retrospective study. Journal of Digestive Diseases, 21(4), 222–229. https://doi.org/10.1111/1751-2980.12858
McCabe, M. E., & Dilly, C. K. (2018). New Causes for the Old Problem of Bile Reflux Gastritis. Clinical Gastroenterology and Hepatology, 16(9), 1389–1392. https://doi.org/10.1016/j.cgh.2018.02.034
Othman, A. A., Dwedar, A. A., ElSadek, H. M., AbdElAziz, H. R., & Abdelrahman, A. A. (2021). Bile reflux gastropathy: Prevalence and risk factors after therapeutic biliary interventions: A retrospective cohort study. Annals of Medicine and Surgery, 72, 103168. https://doi.org/10.1016/j.amsu.2021.103168
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