Bile reflux is a condition characterized by the rise of bile, a digestive fluid produced by the liver and stored in the gallbladder, from the intestine to the stomach; in some cases it is associated with gastroesophageal reflux, thus reaching the throat and mouth.
Unlike gastric reflux, biliary reflux does not respond as well to an improvement in diet and lifestyle, often requiring drugs or, in the most severe cases, a surgical approach.
Eating a meal requires subsequent digestion that the gallbladder empties its bile content into the duodenum. The first track of the intestine is found at the exit of the stomach.
Normally the pylorus, a valve that separates the two organs, prevents the ascent towards the stomach, opening instead only for the discharge of the food present in the stomach; in the event of a malfunction. On the other hand, a displacement in the opposite direction can be observed. Due to the tissues unsuitable to resist the digestive action of bile. The stomach and possibly the esophagus develop a more or less severe inflammatory condition.
When the same mechanism also occurs between the stomach and esophagus. Due to insufficient sealing of the cardia, biliary reflux overlaps with gastroesophageal reflux.
However, it is an uncommon condition in healthy subjects, while it is easier to develop in the presence of gastroesophageal reflux disease, particularly in those with severe esophagitis and/or Barrett’s esophagus.
The main risk factors that can predispose the patient to the development of the disorder include:
In any case, the reason why some patients only develop gastric reflux and others associated with biliary disease is not clear, among the hypotheses two are the most shared:
Signs and symptoms are in part superimposable to gastroesophageal reflux, also because it is often associated with it; in fact, the most common symptoms of bile reflux include:
Persistent bile reflux has been linked to an increased risk of developing stomach cancer, possibly due to the irritating action of bile on the organ walls.
Other possible complications include:
Distinguishing biliary reflux from gastric reflux can be difficult and is rarely possible through a medical examination alone; instrumental tests may be necessary such as:
If lifestyle changes are often sufficient to ensure optimal management of gastroesophageal reflux, unfortunately, the same cannot be said of bile reflux, also due to an objective difficulty in distinguishing the real impact between the two from the patient’s point of view.
Among the drugs that can be used, the most common include:
In patients in whom it is not possible to achieve adequate control of symptoms, surgery can be evaluated in this way, also to reduce the tumor risk associated with the disorder. Even if the real evidence of efficacy is not totally convincing to justify all cases.
Bile reflux seems to respond less well than gastric reflux to lifestyle improvement. However, since they are often associated, it is undoubtedly recommended to take the following advice: