Bile Reflux

Bile reflux occurs when the bile that’s released into your small intestine to help digest food washes back into your stomach, and sometimes into your esophagus.

Normally, everything involved in the digestive process should only flow one way ⁠— down. As food progresses along the digestive tract, valves at the end of each organ open just enough to let food and digestive juices through into the next, without letting anything flow back the other way. But if these valves (sphincters) aren’t functioning right, reflux can happen, and digestive juices like bile can flow back into organs where they don’t belong.

How does bile reflux occur?

Bile is produced in your liver, stored in your gallbladder and released into your small intestine when there are fats there to digest. The pyloric valve lets food out of your stomach and into your small intestine, where it mixes with bile. If the pyloric valve is too relaxed, or maybe obstructed, it doesn’t close properly, and bile can flow back into your stomach.

What is the difference between bile reflux and acid reflux?

If the valve that lets food into your stomach from your esophagus — the lower esophageal sphincter — doesn’t close properly, stomach juices can wash back into your esophagus. This is commonly known as acid reflux. But if you have bile reflux, those juices may contain bile, too. Sometimes, bile is the bigger problem irritating your esophagus.

How does bile reflux affect my body?

Bile is composed of ingredients designed to digest fat. While it isn’t an acidic formula, it’s⁠ harsh on the sensitive linings of your stomach and esophagus. Chronic bile reflux can erode these protective linings, causing painful inflammation and, eventually, tissue damage (esophagitis). You’ll feel it as a burning kind of stomach ache, heartburn or sore throat, or as regurgitation of stomach contents into your esophagus. You may also have frequent nausea, indigestion or even bile vomit.

What are the possible complications of bile reflux?

Chronic inflammation of your stomach lining (gastritis) can lead to stomach ulcers and is associated with a higher risk of stomach cancer. Inflammation of your esophagus (esophagitis) can cause ulcers, scarring and cellular changes to your lining (Barrett’s Esophagus), which is occasionally a precursor to esophageal cancer. These risks are also associated with chronic gastroesophageal acid reflux (GERD), but studies show that bile reflux multiplies the risk.

How common is bile reflux?

Bile reflux is not thought to be common in otherwise healthy individuals. However, acid reflux is very common, and some cases of acid reflux may also be bile reflux. Symptoms of bile reflux and acid reflux are practically identical, and doctors can’t tell if you’re regurgitating bile without actually sampling and analyzing the fluid you regurgitate. This is considered unnecessary when diagnosing acid reflux. But if you’ve been treated for acid reflux and still have symptoms, you might be a candidate for further testing.

Who does bile reflux affect?

Bile reflux is most commonly recognized as a complication of surgery, particularly stomach surgery that bypasses, damages or replaces the pyloric valve. Gallbladder removal surgery (cholecystectomy) may also be associated with bile reflux. When your gallbladder is removed, your liver is redirected to release bile directly into your small intestine. But when bile isn’t stored and concentrated in the gallbladder first, it can overflow into your stomach.