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Biliary reflux

Abnormal flow of intestinal contents into the stomach and esophagus

Summary

Abnormal flow of intestinal contents into the stomach and esophagus

Field	Value
synonyms	bile reflux, duodenogastroesophageal reflux (DGER), duodenogastric reflux
image	Diagram showing the position of the gallbladder and bile ducts CRUK 440.svg
caption	The location of bile duct and gallbladder in relation to stomach
specialty
causes
risks
treatment
frequency
named after

Biliary reflux, also called bile reflux, duodenogastroesophageal reflux (DGER) or duodenogastric reflux, is a condition that occurs when bile and/or other contents like bicarbonate and pancreatic enzymes flow upward (refluxes) from the duodenum into the stomach and esophagus.

Biliary reflux is often mistaken for acid reflux (gastroesophageal reflux disease, GERD). The difference is in the fluid involved:

Acid reflux (GERD): stomach acid moves up into the esophagus.
Bile reflux: bile and enzymes from the small intestine move into the stomach and esophagus.

These conditions are often related, and differentiating between the two can be difficult.

Bile is a digestive fluid made by the liver, stored in the gallbladder, and discharged into the duodenum after food is ingested to aid in the digestion of fat. Normally, the pyloric sphincter prevents bile from entering the stomach. When the pyloric sphincter is damaged or fails to work correctly, bile can enter the stomach and then be transported into the esophagus as in gastric reflux. The presence of small amounts of bile in the stomach is relatively common and usually asymptomatic, but excessive refluxed bile causes irritation and inflammation. Bile reflux has been associated with gastric cancer, chemical gastritis and the development of ulcers.

Symptoms and signs

Frequent heartburn
Pain in the upper part of the abdomen
Vomiting and/or regurgitating bile
Hypersalivation Bile reflux can be asymptomatic when lying down or after eating, as bile reflux occurs physiologically.

Diagnosis

Bile reflux is usually associated with:

Erosive esophagitis
Barrett's esophagus

Management

Ursodeoxycholic acid is an adequate treatment of bile reflux gastritis. The dosage is usually of: Adult(body-weight 47kg and above): 250mg once daily for 10-14 days, dose to be taken at bedtime.

Surgery

Biliary reflux may also be treated surgically, if medications are ineffective or if precancerous tissue is present in the esophagus.

Epidemiology

Obesity is an independent risk factor for development of bile reflux. Bile reflux is very infrequent in healthy individuals. After surgical operations such as a cholecysectomy, bile reflux gastritis occurs in approximately 15-35% of patients, with higher rates in those with gastric emptying or sphincter of Oddi dysfunction.

Bile acids are frequently present in the gastroesophageal refluxate, and thus can cause inflammatory and neoplastic changes in the upper aerodigestive tract. Bile reflux appears to be a causal factor in human hypopharyngeal squamous cell carcinoma. In a mouse study it was shown that acidic bile refluxate causes oxidative DNA damage leading to progressive mutagenic effects and hypopharyngeal squamous cell carcinogenesis.

References

(2011-03-10). "Oxford American Handbook of Gastroenterology and Hepatology". Oxford University Press US.
[http://www.mayoclinic.org/medical-edge-newspaper-2011/aug-05b.html Distinguishing Between Bile Reflux and Acid Reflux can be Difficult]
(2006). "[Duodenogastric and gastroesophageal bile reflux].". Journal de chirurgie.
BNF 84 (British National Formulary)
"Bile reflux - Symptoms and causes".
(2018). "Detecting Bile Reflux-the Enigma of Bariatric Surgery.". Obes Surg.
(2013). "Management of bile reflux". [[Gastroenterol Hepatol (N Y)]].
"Biliary Reflux: Pathophysiology, Epidemiology, and Clinical Overview". Claisen, Inc.
(November 2021). "Bile reflux and hypopharyngeal cancer (Review)". Oncol Rep.
(October 2019). "Biliary reflux as a causal factor in hypopharyngeal carcinoma: New clinical evidence and implications". Cancer.
(April 2020). "The Progressive Mutagenic Effects of Acidic Bile Refluxate in Hypopharyngeal Squamous Cell Carcinogenesis: New Insights". Cancers (Basel).

Wikipedia Source

This article was imported from Wikipedia and is available under the Creative Commons Attribution-ShareAlike 4.0 License. Content has been adapted to SurfDoc format. Original contributors can be found on the article history page.

diseases-of-oesophagus,-stomach-and-duodenum

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