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Treatments and drugs
By Mayo Clinic staff
Ursodeoxycholic acid
One prescription medication for bile reflux treatment is ursodeoxycholic acid, which helps promote bile flow. This medication may lessen the frequency of symptoms and the severity of pain associated with bile reflux. If bile reflux results from delayed stomach emptying, your doctor may prescribe drugs to increase the rate at which food moves through your stomach.
Proton pump inhibitors
Drugs called proton pump inhibitors are often prescribed for the treatment of GERD and Barrett's esophagus. Although the primary purpose of these medications, which include esomeprazole (Nexium) and lansoprazole (Prevacid), is to block acid production, they may also help reduce bile reflux.
Surgical treatments
When medications fail to reduce severe symptoms or there are precancerous changes in the esophagus, doctors sometimes recommend surgery. Because some types of operations are often more successful than others, be sure to discuss the pros and cons carefully with your doctor.
Surgical options include:
- Diversion surgery. Surgeons have successfully used a procedure called a Roux-en-Y (roo-en-wi) operation to treat bile reflux in people who have had previous gastric surgery with pylorus removal (Billroth I or Billroth II). In this procedure, surgeons make a new connection for bile drainage farther down in the intestine, thereby diverting bile away from the stomach.
- Anti-reflux surgery. Typically used to treat acid reflux, this operation — known medically as fundoplication — may be less successful in people who have bile reflux problems, though there is little data about its effectiveness. During the procedure, the part of the stomach closest to the esophagus (fundus) is wrapped and then sewn around the lower esophageal sphincter. This increases the pressure at the lower end of the esophagus and reduces acid reflux. People with bile reflux may continue to have symptoms after fundoplication, however.
- 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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