Bile Reflux

Bile is provided by the liver and delivered to the gall bladder where it is stored and released into the duodenum when required. (See chapter on bile.)

In the stomach, food is broken down by the concentrated acid. However, it doesn’t mix with oily or fatty foods so, as observed by Dr William Beaumot in 1833 “when the use of fat or oily food has been persevered in for some time, there is generally the presence of bile in the gastric fluids” [a-i]

To assist in dissolving fats and animal tissue, the bile acts a bit like dishwasher fluid permitting the acid molecules to attach to the fatty ones. For this to happen, some bile is permitted to flow back wards through the pyloric sphincter rough which partially digested food (chyme) usually exits the stomach into the duodenum for digestion.

It is the backflow of bile through the pyloric sphincter into the stomach that is correctly termed “bile reflux”.

Serious damage may be done to the oesophagus if acid and bile are permitted to reflux via the lower oesophageal sphincter.

From a study published in 2013 in the Journal of Gastrointestinal Surgery,“bile at low pH, but not bile or low pH alone, promotes loss of differentiation status of stratified squamous esophageal epithelium” [“low pH” = acid]

Acid without bile may burn causing blistering, lesions or scars. With bile, it may start to dissolve the lining of the oesophagus. Reducing stomach acid production pre-emptively with a Proton Pump Inhibitor (PPI) or H2 blocker, will mean if any bile is able to reflux from the stomach, it will be relatively harmless.

The term “bile reflux” is frequently misused when someone using PPI medication continues to experience gastro-oesophageal reflux symptoms assuming because there’s no acid, it may be bile that’s causing the discomfort. However, although acid suppressants are excellent in reducing acid, they do not reduce the reflux which needs to be managed by lifestyle or surgery. (See the section on Reflux for more information.)

Updated 19 January 2023