Diseases & Conditions

Bile reflux

You're likely familiar with acid reflux — the backflow of caustic stomach acids into your esophagus, the tube that connects your throat and stomach. Less well known is bile reflux, which occurs when bile — a digestive fluid produced in the liver — flows upward from your small intestine into your stomach and esophagus.

Bile reflux often accompanies acid reflux, and together they're a formidable team, inflaming the lining of your esophagus and potentially increasing your risk of esophageal cancer. Bile reflux also affects your stomach, where it causes further inflammation.

Unlike acid reflux, bile reflux usually can't be completely controlled by changes in diet or lifestyle. Instead, bile reflux is most often managed with medications or, in severe cases, with surgery.

Bile is a greenish-yellow fluid that's essential for digesting and absorbing fats and for eliminating worn-out red blood cells and certain toxins from your body. It's produced in your liver and stored in your gallbladder in a highly concentrated form. Eating a meal that contains even a modest amount of fat signals your gallbladder to release bile, which flows through two small tubes (cystic duct and common bile duct) into the upper part of your small intestine (duodenum).

At the same time, food enters your small intestine through the pyloric valve, a heavy ring of muscle that sits at the outlet of your stomach. Ordinarily, the pyloric valve opens just slightly — enough to release about an eighth of an ounce (about 3.5 milliliters) of liquefied food at a time, but not enough to allow digestive juices to flow back (reflux) into the stomach. In many cases of bile reflux, the valve doesn't close properly, and bile backwashes into the stomach, where it causes irritation and inflammation (gastritis).

Surgical complication
Most damage to the pyloric valve occurs as a complication of gastric surgery, including total removal of the stomach (gastrectomy) and gastric bypass operations for weight loss.

Other causes
Other causes of bile reflux include:

• Peptic ulcer. Sometimes a peptic ulcer can obstruct the pyloric valve. Rather than not closing tightly, the valve doesn't open enough to allow the stomach to empty as quickly as it should. The stagnant food and liquid can lead to increased gastric pressure that causes the refluxed bile and stomach acid to back up into the esophagus.
• Gallbladder surgery (cholecystectomy). People who have had their gallbladders removed have significantly more bile reflux than do people who haven't had this surgery.

Reflux into the esophagus
Bile and stomach acid reflux into the esophagus when another muscular valve, the lower esophageal sphincter, malfunctions. The lower esophageal sphincter separates the esophagus and stomach. Normally, it opens only to allow food to pass into the stomach and then closes tightly. But if the valve relaxes abnormally or weakens, stomach acid and bile can wash back into the esophagus, causing heartburn and ongoing inflammation that may lead to serious complications.