Bile reflux 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 — the backflow of stomach acids into your esophagus, the tube that connects your throat and stomach.
Together bile and acid reflux can have serious consequences, inflaming the lining of your esophagus and potentially increasing your risk of esophageal cancer. Bile reflux also affects your stomach, where it can cause 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 reflux can be difficult to distinguish from acid reflux — the signs and symptoms are similar, and the two conditions may occur at the same time. But unlike acid reflux, bile reflux inflames the stomach, often causing a gnawing or burning pain in the upper abdomen.
Bile reflux symptoms include:
When to see a doctor
If you've been diagnosed with gastroesophageal reflux disease (GERD) but aren't getting adequate relief from your medications, call your doctor. You may need additional treatment for bile reflux.
Bile is a greenish-yellow fluid that's essential for digesting 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).
Bile reflux into the stomach
Bile reflux into the esophagus
What leads to bile reflux?
Stomach and pyloric valve
Your stomach is a muscular sac about the size of a small melon that expands when you eat or drink to hold as much as a gallon of food or liquid. Once your stomach pulverizes the food, strong muscular ...
How heartburn and GERD occur
Acid reflux occurs when the sphincter muscle at the lower end of your esophagus relaxes at the wrong time, allowing stomach acid to back up into your esophagus. This can cause heartburn and other ...
A sticky mucous coating protects the lining of your stomach from the corrosive effects of stomach acid, but the esophagus doesn't have this protection. This lack of protection is why bile reflux and acid reflux can seriously damage esophageal tissue. And although bile reflux can injure the esophagus on its own, the combination of bile and acid reflux seems to be particularly harmful, increasing the risk of complications, such as:
Preparing for your appointment
Make an appointment with your doctor if you have signs or symptoms common to bile reflux. After your doctor's initial evaluation, you may be referred to a specialist in digestive disorders (gastroenterologist).
Here's some information to help you prepare for your appointment and what to expect from your doctor.
What you can do
For bile reflux, some basic questions to ask your doctor include:
In addition, don't hesitate to ask questions during your appointment at any time that you don't understand something.
What to expect from your doctor
Tests and diagnosis
Doctors often can diagnose a reflux problem from a description of symptoms. But distinguishing between acid reflux and bile reflux is difficult and requires further testing. You're also likely to have tests to check for damage to your esophagus and stomach as well as for precancerous changes.
Treatments and drugs
Proton pump inhibitors
Surgical options include:
Lifestyle and home remedies
Unlike acid reflux, which can be caused or aggravated by eating certain foods and by smoking, obesity and excess alcohol consumption, bile reflux seems unrelated to lifestyle factors. But because many people experience both acid reflux and bile reflux, making some lifestyle changes may help relieve your symptoms:
Many people with frequent heartburn use over-the-counter or alternative therapies for symptom relief. Remember that even natural remedies can have risks and side effects, including potentially serious interactions with prescription medications. Always do careful research and talk with your doctor before trying an alternative therapy.
Although no alternative therapies have been found to specifically relieve bile reflux, some have been proven to help protect against and relieve esophageal inflammation. These include:
Last Updated: 2010-01-23
© 1998-2013 Mayo Foundation for Medical Education and Research (MFMER). All rights reserved. A single copy of these materials may be reprinted for noncommercial personal use only. "Mayo," "Mayo Clinic," "MayoClinic.com," "Mayo Clinic Health Information," "Reliable information for a healthier life" and the triple-shield Mayo logo are trademarks of Mayo Foundation for Medical Education and Research.
Terms and conditions of use