Bile Reflux

Diagnosis

Bile reflux is often difficult to distinguish from acid reflux because both conditions share similar symptoms. In most cases, a healthcare professional can begin diagnosis based on your symptoms and medical history. However, additional tests are often needed to confirm bile reflux and assess any damage to the stomach or esophagus.

These diagnostic tests may include:

Endoscopy. A flexible tube with a tiny camera, called an endoscope, is inserted through the mouth to examine the upper digestive tract. It helps identify inflammation, ulcers, or the presence of bile in the stomach and esophagus. During this test, tissue samples may be taken to detect Barrett’s esophagus or early signs of cancer. A small fluid sample from the stomach may also be collected for testing.

Ambulatory acid tests. This test measures how often and how long acid enters the esophagus. It helps rule out acid reflux as a cause of symptoms. A thin, flexible catheter is placed through the nose into the esophagus, where it records acid levels for 24 hours using a small probe.

Esophageal impedance test. This test detects whether gas or liquid, including non-acidic substances such as bile, moves up into the esophagus. Like the acid test, it uses a thin catheter inserted through the nose. This test is especially useful when symptoms occur without acid reflux.

Treatment

Bile reflux treatment focuses on reducing symptoms and preventing damage to the digestive tract. Unlike acid reflux, bile reflux can be harder to treat, and results may vary. Treatment may include lifestyle changes, medication, or in some cases, surgery.

Medications

Several types of medicines may help manage bile reflux and relieve discomfort:

Ursodeoxycholic acid. This medication helps reduce the frequency and severity of symptoms by improving bile flow.

Proton pump inhibitors (PPIs). These drugs lower stomach acid production, helping to reduce irritation in the esophagus and stomach.

Sucralfate. This medicine coats and protects the lining of the stomach and esophagus, creating a barrier against bile and stomach acid.

Bile acid sequestrants. These drugs bind bile acids in the stomach to prevent them from irritating the digestive tract. However, they may cause side effects such as bloating and are sometimes less effective than other options.

Baclofen. This medication reduces the relaxation of the lower esophageal sphincter, preventing bile from flowing backward into the esophagus.

A combination of these medications is often used for best results, depending on the severity of symptoms.

Surgical Treatments

If medications and lifestyle adjustments fail to control bile reflux, surgical treatment may be recommended. Surgery aims to redirect bile flow or strengthen the valve between the stomach and esophagus.

Common surgical options include:

Diversion surgery. This procedure creates a new connection for bile drainage farther down the small intestine. It diverts bile away from the stomach, reducing reflux into the esophagus.

Anti-reflux surgery. In this procedure, the upper part of the stomach is wrapped around the lower esophageal sphincter to strengthen the valve and reduce reflux. While effective for acid reflux, its results for bile reflux can vary.

Surgery is usually considered only when other treatments do not provide relief or when there are precancerous changes in the stomach or esophagus. A detailed discussion with your healthcare provider can help determine the best approach.