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Biliary Reflux - Symptoms, Causes, Diagnosis, Complications, and Treatment

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Bile is a liquid produced in the liver. Reflux means to flow back. Biliary reflux refers to bile flowing back. Read the article to know more about it.

Written by

Dr. Gayathri. N

Medically reviewed by

Dr. Ghulam Fareed

Published At February 14, 2023
Reviewed AtAugust 17, 2023

What Is Bile?

Bile is a liquid produced in the liver and stored in the gallbladder. It helps with digestion. Bile predominantly contains cholesterol. Bile is essential for digesting fats and eliminating certain toxins from the body.

What Is Biliary Reflux?

Biliary reflux occurs when bile backs up into the stomach or the esophagus, a tube made up of muscle that connects the mouth and the stomach. Bile reflux can sometimes be accompanied by gastric acid produced in the stomach, damaging the esophagus. Unlike gastric acid reflux, which can be controlled with dietary changes, bile reflux cannot be altered by changing the diet. Thus, if it occurs, it can be corrected only with medications or, in severe cases, surgery.

What Are the Symptoms of Biliary Reflux?

The symptoms of biliary reflux include:

  • Pain in the upper part of the abdomen.

  • Frequent heartburn (a burning sensation in the chest that can sometimes spread to the throat).

  • Vomiting bile which will be greenish yellow.

  • Nausea.

  • Cough.

  • Hoarseness in the throat.

  • Unexplained loss of weight.

What Are the Causes of This Condition?

1. Bile Reflux Into the Stomach:

During digestion, bile and food mix in the duodenum, the uppermost part of the small intestine. The pyloric valve, which is muscular and is located at the base of the stomach, opens up slightly to release a small quantity of food at a time but does not open wide enough to allow the digestive liquid to go back into the stomach. In the case of biliary reflux, the pyloric valve does not close properly, which would allow the bile to get washed back into the stomach, causing biliary reflux. In addition, this can cause inflammation of the stomach’s inner lining, causing gastritis due to biliary reflux.

2. Bile Reflux Into the Esophagus:

Both bile and acid from the stomach can flow back upwards to the esophagus, which happens when the lower esophageal sphincter, a muscular valve, does not function properly. The sphincter’s primary function is to allow food from the throat into the stomach. If this valve gets impaired, the contents from the stomach and bile can go upwards into the esophagus and cause inflammation in the throat's inner lining.

What Conditions Can Cause These Impairments to Happen?

The conditions include the following:

  • Complications Due to Surgery: Surgeries performed on the stomach, including partial or total stomach removal or gastric bypass surgery performed for weight loss, causes most of the biliary reflux conditions.

  • Peptic Ulcers: Ulcers usually occur when the acid from the stomach causes damage to the lining of the digestive tract. This can block the pyloric valve, which leads to improper opening and closing of the valve. Food that gets stagnant can increase the pressure inside the stomach and allow the acids and bile to move to the esophagus.

  • Removal of Gallbladder: Individuals who have had their gallbladder removed will have more reflux than others.

What Complications Can Occur Due to This Condition?

Biliary reflux can lead to stomach cancer. In addition, this condition can lead to complications as follows:

  • Gastroesophageal Reflux Disease (GERD): This condition can cause inflammation of the esophagus. It is caused due to excess bile or stomach acids. One way of knowing that it is gastroesophageal reflux disease is when the stomach does not respond to acid-suppressant medications.

  • Esophageal Cancer: Prolonged exposure of the esophagus to acids from the bile or the stomach can cause cancer.

How Can This Condition Be Diagnosed?

A complete medical history and the disease symptoms can help the doctor diagnose the disease. The challenge occurs when the doctor differentiates between bile and acid reflux.

Some of the diagnostic tests include:

  • Endoscopy: A thin, flexible tube with a light and camera attached to its tip is passed down the throat into the stomach. This can be seen on a screen connected externally. The doctor will check for any signs of inflammation. The doctor can also take samples from the lining of the stomach or the esophagus to check for any infection or malignancy.

  • Acid Test: This test measures the acid level in the esophagus. It is done using a long flexible probe called the catheter, inserted through the nose into the esophagus. This probe measures the acid level in the esophagus for 24 hours.

  • Bravo Test: In this test, the probe is attached to the lower end of the esophagus while performing an endoscopy to replace the catheter.

  • Esophageal Impedance: This test is useful in determining the type of liquid in the throat. It is helpful in people who regurgitate substances that are not acidic. Biliary reflux cannot be found using a probe to check for acidity.

What Are the Treatment Options for This Condition?

Dietary and lifestyle changes help reduce acid reflux symptoms, but treating bile reflux is difficult comparatively.

The medications that can be used are:

  • Ursodeoxycholic Acid: It helps promote the bile flow, reducing the symptoms of this condition.

  • Sucralfate: This medication will form a protective coating on the lining of the esophagus and the stomach from biliary reflux.

  • Bile Acid Sequestrants: This substance disrupts the circulation of bile. The side effect of this is bloating.

What Are All the Different Surgical Procedures That Can Be Carried Out to Treat This Condition?

  • Antireflux Surgery: In this procedure, the doctor wraps the fundus, the upper part of the stomach, encircling the esophagus to strengthen the valve, which will help reduce acid reflux.

  • Diversion Surgery: In this procedure, the surgeon creates a passage for the bile to drain further lower to the small intestine, which diverts the bile away from the stomach.

What Lifestyle Changes Can Be Followed to Treat This Condition?

The symptoms of bile reflux would not be reduced by making changes in lifestyle or dietary habits. Still, since acid reflux often co-occurs, making some changes may reduce some of the symptoms. The changes that can be made are as follows:

  • Smoking Cessation: Smoking increases stomach acid secretion and dries up the saliva, which helps in protecting the esophagus.

  • Have Smaller Meals: Intake of small amounts of food at frequent intervals helps reduce the pressure on the lower esophageal valve, preventing it from opening at the wrong time.

  • Limit the Intake of Fatty Foods: Foods rich in fat relax the lower esophageal valve and slow down the rate at which the food leaves the stomach.

  • Do Not Lie Down After Eating Food: Staying upright after eating helps digest food quickly.

  • Limit the Intake of Alcohol: Consuming alcohol can relax the lower esophageal valve and cause irritation to the esophagus.

  • Avoid Certain Foods and Beverages: Some foods increase the production of stomach acids which relaxes lower esophageal valves, like caffeinated and carbonated drinks, citrus foods and juices, onions, tomatoes, spicy foods, and mint.

  • Obesity: Acid reflux is more common in obese people since excess weight adds pressure on the stomach.

  • Raise the Head While Sleeping: Sleeping with the upper body raised to four to six inches helps prevent reflux symptoms. Raising the head of the bed is more effective than using extra pillows.

  • Relax: Being tense slows digestion, which can also worsen the symptoms caused due to reflux.


Since biliary reflux more commonly occurs along with acid reflux, treating the symptoms of acid reflux helps ease the symptoms. Following proper dietary habits will also help in controlling the condition. With the recent advancements in science and technology, it has become easy to diagnose diseases, and adequate treatment can be provided to patients experiencing these symptoms.

Frequently Asked Questions


How to Overcome Bile Reflux?

No, bile reflux cannot be completely controlled. To some extent, diet and changes in lifestyle help reduce the symptoms. Medications may be required, and in severe cases, surgery may be done.


Does Stress Cause Biliary Reflux?

Yes, stress causes biliary reflux. There is an increased production of acid in the stomach due to emotional stress. This causes gastroesophageal reflux disease (GERD). In such cases, the lower esophageal sphincter muscle does not work properly.


How to Treat Bile Reflux Gastritis?

Bile reflux gastritis can be treated by diverting the bile away from the gastric mucosa surgically. It is the only effective treatment done to treat bile reflux gastritis.


What Is to Be Eaten if One Has Bile Reflux?

The individual with bile reflux must eat food that is rich in fiber. Eating fibrous food helps reduce blood cholesterol levels and prevent the body from reabsorbing the bile. Eating fruits, vegetables, legumes, cereals, nuts, and seeds help in this condition.


What Is the Difference Between Bile Reflux and Acid Reflux?

In the case of bile reflux, fluid moves from the small intestine to the stomach and esophagus, whereas in the case of acid reflux, there is a backflow of acid into the esophagus from the stomach.


Is Bile Reflux a Serious Condition?

Yes, bile reflux may lead to stomach cancer. When bile reflux and acid reflux occur together, it causes GERD. This condition causes irritation and inflammation of the esophagus.


Does Water Intake Help in Bile Reflux?

Yes, during the later stage of digestion, drinking water helps reduce acidity and symptoms of GERD. There are pockets of high acidity present below the esophagus. Drinking water after a while of having a meal helps in diluting the acid.


Which Foods Cause Bile Reflux?

Foods such as caffeinated, carbonated drinks, chocolate, citrus foods, juices, vinegar-based dressings, onions, tomato-based foods, spicy foods, and mint cause bile reflux.


Can Bile Acid Be Cured?

In some cases, it can be cured, but some may not be cured. Curing bile acid malabsorption ( BAM) depends on the cause. Hence the underlying cause should be treated in order to cure BAM.


Do Gallstones Cause Bile Reflux?

Yes, individuals with gallstones are more prone to duodenogastric reflux of bile acid. This tendency is further increased by the removal of the gallbladder.


Is Bile Reflux Gastritis Common?

Bile reflux gastritis is not common. It may be due to complications of certain surgeries. According to a study conducted, bile reflux gastritis is 23.9 percent of the population that was included in the study.


Whether Pantoprazole Stop Bile Reflux?

No, Pantoprazole, a proton pump inhibitor helps reduce acid reflux and bile reflux. Bile reflux cannot be stopped by making changes in diet and lifestyle. Medications are required along with this, and sometimes surgery may be required to fix this problem.


Does Milk Affect Bile Reflux?

Yes, dairy products made of milk may cause bile reflux. Milk may trigger GERD. Though directly it may not cause GERD but it may worsen the situation.


Which Is the Best Fruit for Bile Reflux?

Banana is considered to be the best fruit for bile reflux. Other fruits that are non citric, like apples, melons, and pears, can be used in bile reflux cases. Bananas are good for neutralizing stomach acid because it contains high potassium and is low in pH or acidity.


Is Bile Reflux Acidic?

Bile is not acidic. It is alkaline and contains bile salts, bile pigments, cholesterol, and lecithin. The ingredients help in digesting fat. But it may erode the linings of the stomach and esophagus and lead to inflammation and tissue damage.


For How Long Does Bile Acid Last?

Bile acids in the small intestine help in digesting fat and its absorption. Once the work is done, the remaining will get reabsorbed into the circulation. This gets recycled in the liver into bile again.
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Dr. Ghulam Fareed
Dr. Ghulam Fareed

Medical Gastroenterology


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