Consequences of bile reflux

The article is professionally consulted by Master, Doctor Dang Xuan Cuong - Emergency Resuscitation Department - Vinmec Hai Phong International General Hospital. The doctor has 14 years of experience in the field of emergency resuscitation and poison control.

Bile reflux is a condition in which bile flows from the duodenum into the stomach and esophagus. If left untreated, bile reflux can lead to many dangerous complications such as gastroesophageal reflux disease, esophageal ulcers, and esophageal cancer.

1.1 What is bile translation? Bile is secreted from the liver, yellow or greenish in color, bitter in taste and alkaline (pH 7 - 7.7). Every day, the liver secretes about 700-800ml of bile, which is carried through the bile ducts, condensed and stored in the gallbladder. At meals, the gallbladder will contract and move bile from the gallbladder into the duodenum to perform the task of digesting food. The amount of bile secreted more or less depends on the amount of fat in the food. If there is no fat in the food, the secretion of bile is reduced.
Functions of bile:
Bile digests fats, helps the body absorb fat-soluble vitamins such as A, D, E, K; at the same time stimulate increased secretion and activation of intestinal fluid, pancreatic juice; create an alkaline environment in the intestine, stimulate intestinal peristalsis and inhibit the activity of rotten fermenting bacteria; Bile helps remove bilirubin (degradation product of hemoglobin in red blood cells). 1.2 What is bile reflux? Between the stomach and duodenum, there is a pyloric valve that opens when food needs to be brought down to the intestine and closes immediately to prevent food from refluxing into the stomach. However, if for some reason the pyloric valve does not close properly or opens and closes at the wrong time, bile from the duodenum will back up into the stomach. In the case of an open heart valve, bile can back up into the esophagus. This is bile reflux.

Gastric - duodenal ulcer: This disease makes the activity of the stomach stagnate, food is not digested but stagnates in the stomach for a long time, increasing gastric pressure, making the pyloric and cardiac muscles weak. , easy to cause bile reflux; Complications after gastrectomy: After surgical procedures in the stomach such as removal of part of the stomach or gastric bypass surgery to lose weight in obese people, the pyloric valve may not function properly. , causing the phenomenon of tight closure, creating conditions for bile from the duodenum to back up into the stomach; Gallbladder surgery: Studies have shown an increased risk of bile reflux in patients who have had gallbladder surgery.

Epigastric abdominal pain, pain or intermittent pain, burning sensation, gnawing in the chest and upper abdomen; Heartburn, bitter mouth; Dry cough, hoarseness due to bile reflux from the duodenum, stomach to the esophagus; Vomiting greenish-yellow liquid, bitter throat (specific symptoms suggest bile reflux); Abdominal bloating, slow digestion and weight loss.

When bile flows back from the duodenum to the stomach, it causes inflammation of the gastric mucosa. Bile reflux is also one of the causes of gastroesophageal reflux. When bile refluxes into the esophagus and pharynx junction, the patient will have a bitter feeling in the mouth, vomit green - yellow fluid, may have cough, edema of the vocal cords and loss of voice,... Serious more, patients are at risk of Barrett's esophagus, esophageal cancer, stomach cancer,...

To diagnose bile reflux, gastroscopy is usually indicated by the doctor. After anesthesia, the patient underwent endoscopy. Through endoscopy, the doctor can see the image of bile flowing from the duodenum to the stomach, bile pools, lesions of the stomach, esophagus, ...

Does bile reflux go away on its own? The disease often cannot be cured on its own but needs to be treated with the following methods:
6.1 Use of drugs Drugs that reduce or eliminate bile: Questran, Colestid and cisapride. In which, Cisaprid is used to treat children's diseases; Proton pump inhibitors These drugs can relieve symptoms of the disease, but there are many unwanted side effects. When using the above drugs, patients need to strictly follow the doctor's instructions on dosage, duration,...
6.2 Surgery Surgical methods to treat bile reflux include:
Methods Antireflux: The goal of surgery is to ensure the ability of the esophageal sphincter to contract. When the sphincter tightens, acid and bile cannot back up. This method is done by: wrapping the part of the stomach near the esophagus and then stitching it around the esophageal sphincter; Roux-en-Y method: The cure rate of bile reflux disease with this method is 50 - 90%. With this method, the doctor will make a bile duct that connects to the jejunum (the back part of the duodenum). When the liver secretes bile, bile will be transferred to the jejunum instead of pouring directly into the duodenum as before and will prevent bile reflux from the duodenum to the stomach. 6.3 Changing living habits People who are suffering from bile reflux should follow the following guidelines to control the disease effectively:
Divide into several meals a day, do not eat too much in each meal; Avoid high-fat foods, onions, tomatoes, vinegar, chocolate, citrus, spicy foods; Do not use alcohol, beer, coffee, carbonated drinks; Do not lie down, sleep right after a meal because after eating is the time when bile is secreted the most, so if you lie down, the bile will easily move from the duodenum to the stomach and esophagus. You should lie down after eating for about 1 hour, when sleeping, you need to put your head about 10-15cm higher than your feet; No smoking; Maintain a healthy body weight by exercising properly. Obese people with thick abdominal fat will increase abdominal pressure, causing reflux. Maintaining a reasonable body weight is a way to reduce the risk of reflux. However, patients should pay attention not to practice twisting movements of abdominal muscles such as abdominal muscles, badminton, tennis, ... to avoid the risk of bile reflux disease progressing worse; Do not stay up too late and limit nervous stress. Bile reflux can cause many dangerous complications, so when there are warning symptoms, patients should go to the doctor early for timely diagnosis and treatment.