Have you ever heard of bile reflux? For many people, the word “reflux” is almost synonymous with a condition known as “acid reflux,” which occurs when stomach acid backs up (refluxes) towards the esophagus and causes unpleasant sensations, including what is commonly referred to as heartburn. While occasional heartburn is common, chronic acid reflux flare-ups can be painful, draining, and frightening, especially if they occur during the nighttime.
Burning sensations in the throat and chest, coughing or choking, and feelings of panic or distress during sleep are commonly associated with chronic acid reflux; however, what many do not know is that they can also be associated with bile reflux.
Bile reflux is a condition in which bile from the liver, a naturally-produced substance that generally catalyzes the digestion of fats, backs up (refluxes) into the stomach and even into the esophagus. When this occurs, it can produce symptoms that are highly similar to those of acid reflux. However, one of the most important distinctions is that bile reflux symptoms do not usually alleviate with dietary or lifestyle changes
The similarities between acid reflux and bile reflux, which we will explore in more detail below, are why it is incredibly important for you to talk to your physician if you’re experiencing acid reflux symptoms that aren’t lessening with traditional acid treatment.
Created by the liver, Bile is a green to dark yellow mixture of digestive salts that passes from the liver into the gallbladder and then, later, into the upper small intestine. Bile is uniquely equipped to help the body digest fats, as the digestive acids within separate and isolate fats to break them down apart from other components of food. Bile is less acidic than stomach acid, which helps it fulfill its second purpose: Nullifying stomach acid before it reaches the lower intestine.
When you consume a meal with fat in it, your gallbladder receives signals from your stomach to release bile into the small intestine in preparation for the digestion of fat. The bile accumulates in the upper small intestine and, normally, remains there as food and stomach acid pass from the stomach.
In the occurrence of bile reflux, the section of the stomach that connects with the small intestine known as the Pyloric Valve does not close quickly enough or tightly enough, which causes bile to flow back into the stomach. From there, it can then come in contact with the lower esophageal sphincter, the opening that connects the esophagus to the stomach.
If the esophageal sphincter is also weak or overly-relaxed, bile can then flow up (reflux) into the esophagus causing a number of unpleasant symptoms.
Sometimes, bile reflux and acid reflux can occur at the same time, since bile backflow often mixes with stomach acid in the stomach.
The following symptoms are most commonly associated with bile reflux:
It’s important to pay special attention to any occurrence of vomiting in which bile is clearly present. While rare occurrences of intense vomiting can lead to expelling bile, regularly occurring vomiting with bile present should be taken as a potential signifier of bile reflux.
Many of the symptoms of bile reflux are shared with acid reflux, which is part of what makes bile reflux more difficult to pinpoint than acid reflux. If you are experiencing frequent heartburn, choking while sleeping, and bad taste in the back of your throat, you should talk with your doctor about looking into treatments for acid reflux.
If acid reflux treatments do not prove effective, it may be related to bile instead of stomach acid. Because of the difference in chemical makeup between bile and stomach acid, many of the treatments that relieve the overproduction and/or backup of stomach acid do not eliminate or nullify bile. This fact means that a process of elimination may be necessary to identify bile reflux.
