Bile Reflex
Question Received:
Response:
I went for a gastroscopy, and the results have come back that I had excess bile in the stomach. This causes daily nausea and acid in the esophagus and I would like too know what operations or treatment are possible so I know for future reference.
4th July 2005
As you probably know, when we swallow food and
liquids they go first to the stomach, and then move onwards to the beginning of
the small intestine, which is called the duodenum. Half way along the duodenum
there is a tiny opening through which bile and pancreatic juice are added to the
partially-digested food. So the normal movement of food is from stomach to
duodenum and then onwards. Occasionally, though, some of the contents in the
duodenum may pass back the other way, back into the stomach. The contents of the
stomach are very acid – the hydrochloric acid is secreted by special glands in
the wall of the stomach. In contrast with this, the secretions going into the
duodenum are alkaline, including the bile. This is in order to neutralise the
stomach acid coming along with the food and make conditions suitable for the
next stages of digestion.
The movement of bile and pancreatic juice into the stomach is called
duodenogastric reflux.
It probably happens in all of us to a small degree, but usually not enough to create any problems. The part of the stomach that controls the movement of food from stomach to duodenum is called the pyloric sphincter. This is a ring of muscle that can contract and close the passage way, or relax and allow the food to pass through. If excessive duodenogastric reflux is occurring, it may be because there is a problem with the pyloric sphincter. For example, there may be an ulcer on its inner surface, or it may have been operated on sometime before. When reflux of bile and pancreatic juice occurs, the lining of the stomach becomes irritated and inflamed (gastritis), and the contents of the stomach can then reflux up into the lower part of the oesophagus, irritating that too (oesophagitis). These changes give rise to the pain and nausea that you describe.
Having identified the problem, I expect your doctor will discuss with you what the options are. One possibility is to take medications that bind to the chemicals in bile to reduce the irritating effect that they have on the stomach. If there is a problem with your pyloric sphincter, your doctor will be able to start treatments to put that right. For example, some ulcers can be cured with a course of antibiotics. There may be lifestyle changes that you can make that will reduce the problem – changes in diet, regular meal times, avoidance of irritating substances, reduction of stress, exercise etc. Operations are possible, but they are seen as the last resort after the other treatments have been tried unsuccessfully.