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Causes
By Mayo Clinic staff
Bile is a greenish-yellow fluid that's essential for digesting fats and for eliminating worn-out red blood cells and certain toxins from your body. It's produced in your liver and stored in your gallbladder in a highly concentrated form.
Eating a meal that contains even a modest amount of fat signals your gallbladder to release bile, which flows through two small tubes (cystic duct and common bile duct) into the upper part of your small intestine (duodenum).
Bile reflux into the stomach
At the same time that bile is entering the duodenum, food enters your small intestine through the pyloric valve, a heavy ring of muscle located at the outlet of your stomach. Ordinarily, the pyloric valve opens just slightly — enough to release about an eighth of an ounce (about 3.5 milliliters) of liquefied food at a time, but not enough to allow digestive juices to backup (reflux) into the stomach. In many cases of bile reflux, the valve doesn't close properly, and bile backwashes into the stomach, where it causes irritation and inflammation (gastritis).
Bile reflux into the esophagus
Bile and stomach acid reflux into the esophagus when another muscular valve, the lower esophageal sphincter, malfunctions. The lower esophageal sphincter separates the esophagus and stomach. Normally, it opens only to allow food to pass into the stomach and then closes tightly. But if the valve relaxes abnormally or weakens, stomach acid and bile can wash back into the esophagus, causing heartburn and ongoing inflammation that may lead to serious complications.
What leads to bile reflux?
Bile reflux may be caused by:
- Gastric surgery complications. Most damage to the pyloric valve occurs as a complication of gastric surgery, including total removal of the stomach (gastrectomy) and gastric bypass operations for weight loss.
- Peptic ulcers. Sometimes a peptic ulcer can block the pyloric valve. Rather than not closing tightly, the valve doesn't open enough to allow the stomach to empty as quickly as it should. The stagnant food and liquid in the stomach can lead to increased gastric pressure that causes refluxed bile and stomach acid to back up into the esophagus.
- Gallbladder surgery (cholecystectomy). People who have had their gallbladders removed have significantly more bile reflux than do people who haven't had this surgery.
- Mercer DW, et al. Peptic ulcer disease. In: Townsend CM, et al. Sabiston Textbook of Surgery. 18th ed. Philadelphia, Pa.: Saunders Elsevier; 2007. http://www.mdconsult.com/das/book/body/169271004-2/0/1565/453.html?tocnode=54738708&fromURL=453.html. Accessed Oct. 15, 2009.
- Lee EL, et al. Gastritis and gastropathies. In: Feldman M, et al. Sleisenger & Fordtran's Gastrointestinal and Liver Disease. 8th ed. Philadelphia, Pa.: Saunders Elsevier; 2006. http://www.mdconsult.com/das/book/body/165017723-5/902729765/1389/357.html#4-u1.0-B1-4160-0245-6..50054-8--cesec51_2169. Accessed Oct. 15, 2009.
- Dawson PA. Bile secretion and the enterohepatic circulation. In: Feldman M, et al. Sleisenger & Fordtran's Gastrointestinal and Liver Disease. 8th ed. Philadelphia, Pa.: Saunders Elsevier; 2006. http://www.mdconsult.com/das/book/body/1650177237/0/1389/450.html?tocnode=51640881&fromURL=450.html#4-u1.0-B1-4160-0245-6..50066-4_2774. Accessed Oct. 15, 2009.
- Heartburn, gastroesophageal reflux (GER), and gastroesophageal reflux disease (GERD). National Digestive Diseases Information Clearinghouse. http://digestive.niddk.nih.gov/ddiseases/pubs/gerd/. Accessed Oct. 15, 2009.
- Yardley JH, et al. Acute hemorrhagic erosive gastropathy and chronic chemical gastropathy. http://www.uptodate.com/home/index.html. Accessed Oct. 15, 2009.
- Fass R. Approach to refractory gastroesophageal reflux disease in adults. http://www.uptodate.com/home/index.html. Accessed Oct. 15, 2009.
- Kiefer D. Gastroesophageal reflux disease. In: Rakel RE. Integrative Medicine. Philadelphia, Pa.: Saunders Elsevier; 2007. http://www.mdconsult.com/das/book/body/165168078-5/903199144/1494/89.html#4-u1.0-B978-1-4160-2954-0..50046-6_2173. Accessed Oct. 15, 2009.
- Picco MF (expert opinion). Mayo Clinic, Rochester, Minn. Nov. 24, 2009.
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