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Treatments and drugs
By Mayo Clinic staffAlthough treatments for acid reflux can be very effective, medications for bile reflux may not be helpful for many people. There is little evidence assessing the effectiveness of bile reflux treatments, in part because of the difficulty of establishing bile reflux as the cause of symptoms.
Medications
- Bile acid sequestrants. These medications, which disrupt the circulation of bile, may be helpful for some people with bile reflux. Side effects, such as bloating, may be severe.
- Ursodeoxycholic acid. This medication helps promote bile flow. It may lessen the frequency and severity of your symptoms.
- Prokinetic agents. These medications can help your stomach empty more rapidly and help tighten the lower esophageal sphincter. These medications have several side effects, including fatigue, depression, anxiety and other neurological problems.
- Proton pump inhibitors. These medications are often prescribed to block acid production, but they don't have a clear role in treating bile reflux.
Surgical treatments
Doctors may recommend surgery if medications fail to reduce severe symptoms, or there are precancerous changes in your esophagus. Some types of surgery can be more successful than others, so be sure to discuss the pros and cons carefully with your doctor.
The options include:
- Diversion surgery (Roux-en-Y). This procedure may be recommended for people who have had previous gastric surgery with pylorus removal (Billroth I or Billroth II). In Roux-en-Y, surgeons make a new connection for bile drainage farther down in the small intestine, diverting bile away from the stomach.
- Anti-reflux surgery (fundoplication). The part of the stomach closest to the esophagus (fundus) is wrapped and then sewn around the lower esophageal sphincter. This procedure strengthens the valve and can reduce acid reflux. There is little evidence about the surgery's effectiveness for bile reflux.
References
- Mercer DW, Townsend CM, et al. Sabiston Textbook of Surgery: The Biological Basis of Modern Surgical Practice. 18th ed. Philadelphia, Pa.: Saunders Elsevier; 2008. http://www.mdconsult.com/das/book/body/169271004-2/0/1565/453.html?tocnode=54738708&fromURL=453.html. Accessed Jan. 2, 2012.
- Feldman M, et al. Sleisenger & Fordtran's Gastrointestinal and Liver Disease: Pathophysiology, Diagnosis, Management. 9th ed. Philadelphia, Pa.: Saunders Elsevier; 2010. 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 Jan. 2, 2012.
- Heartburn, gastroesophageal reflux (GER), and gastroesophageal reflux disease (GERD). National Digestive Diseases Information Clearinghouse. http://digestive.niddk.nih.gov/ddiseases/pubs/gerd/. Accessed Dec. 31, 2011.
- 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 Jan. 2, 2012.
- Wang DH, et al. Aberrant epithelial-mesenchymal hedgehog signaling characterizes Barrett's metaplasia. Gastroenterology. 2010;138:1810.
- Richter JE. Role of the gastric refluxate in gastroesophageal reflux disease: acid, weak acid and bile. American Journal of the Medical Sciences. 2009;338:89.
- Yamada T, et al. Bile-acid-induced calcium signaling in mouse esophageal epithelial cells. Biochemical and Biophysical Research Communications. 2011;414:789.
- Cheng P, et al. Effects of refluxate pH values on duodenogastroesophageal reflux-induced esophageal adenocarcinoma. World Journal of Gastroenterology. 2011;17:3060.
- Picco MF (expert opinion). Mayo Clinic, Rochester, Minn. Jan. 15, 2012.
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