Bile Reflux: Symptoms, Causes, and Treatment

Jan 06, 2024

Bile reflux is a condition in which the bile backs up into the stomach and/or the esophagus. Bile is a digestive liquid produced by the liver and is used by the intestines to digest food.

Changing the diet or making lifestyle changes may not help with the symptoms of bile reflux. The condition may be managed with medications, but in some cases surgery could also be needed.

This article discusses the symptoms and potential causes of bile reflux. It also covers risk factors and when to seek tests or treatment for your symptoms.

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Acid reflux is a condition that causes stomach acid to flow back up into the esophagus. Bile reflux is a different condition because it occurs when bile flows into the stomach or esophagus. However, both conditions can be present in the same person.

The symptoms of bile reflux are similar to several other conditions. For that reason, it's important to have new symptoms or changes in any digestive symptoms checked out by a healthcare provider.

Some of the symptoms of bile reflux include:

There are several reasons that someone might develop bile reflux. The underlying cause may be:

Surgical complications: People who have had surgery on their stomach may develop bile reflux. Weight loss procedures (bariatric surgery) are the most common surgeries resulting in bile reflux. Surgery to remove the gallbladder is also associated with a higher risk of bile reflux.

Stomach reflux: The pyloric valve is located where the stomach meets the small intestine. It opens to allow food to pass from the stomach into the first part of the small intestine (the duodenum).

It's a small opening, and it's only supposed to allow the stomach contents to pass one way. However, if the pyloric valve doesn't close all the way, it could allow bile to flow into the stomach instead of the small intestine.

A peptic ulcer is a sore in the lining of the esophagus, stomach, or duodenum. If an ulcer affects the pyloric valve, it could prevent the valve from opening and closing properly. This could allow bile to back up into the stomach.

Esophageal reflux: The lower esophageal sphincter is a valve at the bottom of the esophagus. It opens up to allow food to pass from the esophagus into the stomach. Food is not supposed to come back up into the esophagus. However, if the lower esophageal sphincter is weak or too relaxed, food and bile can come back up into the esophagus.

With other types of reflux, treatment often focuses on changing the diet or other lifestyle factors. However, that won't help with bile reflux. This is why it's important to get a diagnosis. However, determining whether symptoms are from bile reflux—and not another type of reflux or a different condition—can be challenging.

Some medications are used to treat bile reflux. Bile reflux isn't well studied, so it may take some trial and error to find the medication that will work to help get symptoms under control.

Bile acid sequestrants: These medications might also be called bile acid resins (BAR). They bind with the bile. That causes the bile to become ineffective, and it passes out of the body in stool. These include:

These medications might cause symptoms such as nausea, bloating, or gas that are severe enough that some people may not want to take them.

Carafate (sucralfate): This medication is used to treat peptic ulcers. It works by coating the lining of the stomach and the small intestine. The drug isn't absorbed by the body, so it is a layer that protects the inside of these organs from being further harmed by the bile.

Actigall or Urso 250 or Urso Forte (ursodiol): This is a type of a bile acid that has an effect on the liver. It is a small part of the overall composition of bile. It has been used to treat certain liver diseases and disorders of the bile ducts. It can have side effects of diarrhea, nausea, or vomiting.

Having bile acids flow into the stomach or esophagus can cause damage and inflammation. If this continues for a long time, it can increase cancer risk. Surgery might be considered for people still having symptoms even after trying to treat them with medications. The types include:

Over time, having bile reflux can lead to problems in the stomach and esophagus. Exposure to bile can cause inflammation in those areas. This inflammation could lead to complications such as ulcers. Bile reflux could be complicated with also having gastroesophageal acid reflux (GERD).

Having ulcers and inflammation (gastritis) in the stomach from reflux is associated with developing gastric cancer. Ongoing inflammation in the esophagus can lead to a condition called Barrett's esophagus, which also may increase the risk of cancer.

Some of these risks are not well studied, so how often they occur is still not understood. It's thought that developing cancer due to bile reflux after having gastric bypass surgery may be uncommon or even rare.

Bile reflux isn't always easy to diagnose. Reflux might be suspected or diagnosed based on the symptoms. But knowing that it is from bile reflux may take more investigating.

Some of the tests that might be used include:

Acid reflux is a common problem and has symptoms that are similar to bile reflux. It might not be possible to tell the difference between the two without testing. Treatments meant for acid reflux may not be helpful for bile reflux.

People should think about seeing a healthcare provider when they’re having upper abdominal symptoms that are ongoing and aren't getting any better with changing the diet. Bile reflux isn't treatable with home remedies, so getting a diagnosis from a healthcare provider is going to be the way to get it under control.

If abdominal pain is severe or there are symptoms such as bleeding, vomiting, or diarrhea that won't stop, see a healthcare provider immediately or go to the emergency room (ER).

Bile reflux has symptoms that are similar to other, more common conditions such as GERD. However, this condition is more difficult to diagnose and treat, and may be associated with more risks of complications. For that reason, symptoms of reflux that aren't getting any better may be a reason to seek out a healthcare provider for a diagnosis, to either rule out or diagnose bile reflux.

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By Amber J. TrescaAmber J. Tresca is a freelance writer and speaker who covers digestive conditions, including IBD. She was diagnosed with ulcerative colitis at age 16.