Bile reflux is a medical condition characterized by a backflow of bile from the small intestine into the stomach and up to the esophagus and throat. Bile is a digestive fluid synthesized in the liver, essential for digesting fat. It is under normal circumstances not found in the stomach or esophagus and its presence is associated with the inflammation of these organs.
This is a serious health issue which requires adequate treatment. Medications may help people suffering from bile reflux. However, many times patients require surgery because the condition cannot be controlled with conservative treatments.
Bile Reflux Symptoms
It is actually quite challenging to differentiate bile reflux from acid reflux. This is because the symptoms and signs of both of these conditions are quite similar, sometimes completely the same.
Common bile reflux symptoms are mild to severe upper abdominal pain, repeated heartburn, nausea and vomiting bile. Cough is a consequence of prolonged bile reflux. Similarly if the condition lasts too long, one may develop hoarseness. Finally, patients suffering from bile reflux may lose weight.
Pathophysiology of Bile Reflux Disease
Bile synthesis and elimination into the small intestine is induced by the presence of fat in the gastrointestinal tract. Once eliminated from the liver (via the cystic duct and the common bile duct) bile enters the duodenum.
Inside the small intestine bile helps digestion of fat and helps its absorption. It is suppose to travel down the gastrointestinal tract. However, this digestive fluid may enter the stomach and even move upward to the esophagus and throat. This occurs only if the muscles of the stomach and the lower portion of the esophagus do not close sufficiently. Entrance of bile into the stomach causes gastritis and in the esophagus esophagitis.
Bile Reflux Causes
Bile reflux may be a complication of gastric surgery. In such case it develops as a consequence of damage to the pyloric valve.
Peptic ulcers may sometimes be located near the pyloric valve. Their healing can cause scarring which subsequently leads to inadequate opening and closing of the lower portion of the stomach.
Finally, bile reflux is more common in people who have undergone cholecystectomy, a surgical removal of the gallbladder.
Bile Reflux Complications
Heartburn and gastroesophageal reflux disease are common complications of bile reflux disease. They subsequently lead to persistent inflammation of the esophagus (chronic esophagitis). Prolonged inflammation of the inner lining of the esophagus may cause esophageal narrowing and subsequent swallowing difficulties.
Recurrent entrance of bile inside the esophagus is also a potential cause of Barrett's esophagus. In Barrett's esophagus the irritation of the esophageal tissue is a trigger for structural changes of the superficial layer. These changes are considered precancerous and may easily transform into invasive cancer.
Finally, apart from chronic esophagitis, bile reflux is also a contributor to chronic gastritis.