What Is Stomach Bile And How Does It Work
Bile is made up of water, electrolytes, cholesterol and phospholipids, according to Colorado State University. It’s stored in your gallbladder until you eat, then it’s secreted into your small intestine to help you digest the fat in your food.
Bile helps your body break down fat by emulsifying it and making it more soluble for digestion. Once you’ve digested your food, the byproducts of stomach bile â like cholesterol â are either recycled or eliminated from your body, per Colorado State University.
But a condition called bile reflux may occur if bile backs up into your stomach and, in some cases, your esophagus , according to the Mayo Clinic. It can cause symptoms like:
- A cough or hoarseness
- Unintended weight loss
These signs are a call to action to get rid of excess bile in the stomach and establish a better balance of acids, which can be regulated by a diet for bile reflux . Eating foods that absorb bile and lower your cholesterol may help relieve your digestive discomforts.
Work with your doctor or dietitian to make sure your bile gastritis diet meets all of your health and nutritional needs.
How Is Bile Acid Malabsorption Diagnosed
The main investigation for a definitive diagnosis of bile acid malabsorption is a nuclear medicine test called the SeHCAT scan. An artificial bile acid SeHCAT is swallowed via a capsule or drink and a first scan is carried out on the same day to establish how much artificial bile acid is in the body the starting amount. One week later a second scan will show how much has been retained. The overall result can establish how much bile acid is lost from the body and whether malabsorption is taking place. The amount of radiation in the test is very small and extra precautions are not necessary. Sometimes, doctors may prescribe treatment instead of testing as the response to medication can make the diagnosis difficult .
Treatment Of Yellow Bile Reflux
Simple lifestyle changes can help you ease and manage bile reflux, including:
- Eat smaller but frequent meals.
- When lying down, ensure that your head is raised 10 to 20 cm so that food does not go back to your mouth from the stomach
- If you’re overweight, try to lose weight.
- Avoid stressful situations and try to relax as much as possible.
- Eat your evening meals 2 or 3 hours before going to bed.
- Avoid smoking and alcohol and also avoid the intake of secondary smoke whenever possible.
- Always seek a doctorâs advice before taking any medication.
- Drink plenty of clean water for hydration.
To be sure, always seek the advice and opinion of a qualified healthcare practitioner who can offer personalized treatment suggestions.
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Check If You Have Acid Reflux
The main symptoms of acid reflux are:
- heartburn a burning sensation in the middle of your chest
- an unpleasant sour taste in your mouth, caused by stomach acid
You may also have:
- a cough or hiccups that keep coming back
- a hoarse voice
Your symptoms will probably be worse after eating, when lying down and when bending over.
What Treatments Are Available For Bile Acid Malabsorption
Treatment mainly includes medication and dietary changes. If there is an underlying condition treatment of the underlying condition can lead to improvement of symptoms.
These work by binding to the bile acid in the small intestine and preventing them from irritating the large intestine. These are called bile acid sequestrants and can help symptoms and improve the quality of the life of sufferers. They will affect the absorption of other drugs so must be taken four hours before or after other medications.
The main medications include:
Following a diagnosis of bile acid malabsorption, a referral to a dietitian may be advised, and a key piece of dietary advice may be to keep to a strict low-fat diet . A dietitian may advise on other specialised diets on an individual basis.
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Bile Acid Malabsorption Symptoms
- watery diarrhoea – often yellow and greasy in appearance
- needing the toilet often
- abdominal cramps
- excessive, smelly wind
Other symptoms can be similar to those of Irritable Bowel Syndrome , like bloating, excessive wind, and abdominal cramps. People who have bile acid malabsorption may also be at risk of vitamin B12 deficiency because the nutrient is absorbed in the ileum, the same place as bile acids.
So, if this section of the small bowel is damaged or diseased and vitamin B12 absorption is affected, it can cause symptoms like shortness of breath and feeling tired all the time. Therefore, in some people with bile acid malabsorption, fatigue may be a symptom. Bile acid malabsorption and joint pain are also reported by some patients.
What Leads To Bile Reflux
Bile reflux may be caused by:
- Surgery complications. Stomach surgery, including total or partial removal of the stomach and gastric bypass surgery for weight loss, is responsible for most bile reflux.
- Peptic ulcers. A peptic ulcer can block the pyloric valve so that it doesn’t open or close properly. Stagnant food in the stomach can lead to increased gastric pressure and allow bile and stomach acid to back up into the esophagus.
- Gallbladder surgery. People who have had their gallbladders removed have significantly more bile reflux than do people who haven’t had this surgery.
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Treatment Of Bile Acid Diarrhea
If your BAD is the result of an identifiable disease, your doctor will treat the disease itself. If no underlying cause can be identified, BAD is usually treated with medications called bile acid sequestrants or binders.
Bile acid sequestrants are FDA-approved to treat high blood cholesterol. They are prescribed off-label to treat BAM.
These medications bind to bile acids and reduce their effects on the large intestine. This class of drugs includes:
These medications are usually effective in treating the symptoms of BAD. Unfortunately, they are not well-tolerated by many patients. Side effects can include constipation and other digestive symptoms.
Because of this, patients may choose to discontinue treatment, especially if they have not received a diagnosis. If you are prescribed one of these medications, be sure to work with your doctor to find the right dose.
Drugs in this class may affect the absorption of other medications. For that reason, you should take them four to six hours before or after any other medications.
What You Can Do
- Write down any symptoms you’ve been experiencing and for how long.
- Make a list of your key medical information, including any other conditions for which you’re being treated and the names of any medications, vitamins or supplements you’re taking.
- Find a family member or friend who can come with you to the appointment, if possible. Someone who accompanies you can help remember what the doctor says.
- Write down questions to ask your doctor. Creating your list of questions in advance can help you make the most of your time with your doctor.
Don’t hesitate to ask questions during your appointment. Some questions to ask your doctor include:
- Do I have bile reflux?
- What treatment approach do you recommend?
- Are there any side effects associated with these treatments?
- Are there any lifestyle or dietary changes I can make to help reduce or manage my symptoms?
- I have other health conditions. How can I best manage them together?
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C Cholestasis: Excess Bile Due To Impaired Bile Excretion
Bile may increase inside your blood and body tissue due to impaired excretion from the liver.
In such a case, there is no increase in bile production but an accumulation of the bile inside your body due to impaired excretion.
The condition is called , and it occurs due to various conditions such as:
- Obstruction of bile flow due to liver diseases .
- Block of the bile ducts delivering bile from the liver to the digestive tract (obstructive jaundice.
The causes of hepatocellular jaundice and obstructive jaundice are in the table below .
|â Stone inside the common bile duct.â Pancreatic cancer or severe acute pancreatitis.â Bile duct stensos or stricuture.â duodenal cancer obstructs the opening of CBD.|
The symptoms are highly variable and depend on the original cause of excess bile in your body.
- Symptoms of jaundice: dark urine, yellow skin, Yellow eye whites, Pale stools.
- Symptoms of acute liver disease include right upper abdominal pain, fatigue, and jaundice.
- Symptoms of liver cirrhosis include swelling of the abdomen, swelling of the lower limbs, black stools, vomiting of blood, coma , muscle wasting, etc.
- Symptoms of biliary problems: such as biliary colic .
Bile Reflux Into The Stomach
Bile and food mix in the duodenum and enter your small intestine. The pyloric valve, a heavy ring of muscle located at the outlet of your stomach, usually opens only slightly enough to release about an eighth of an ounce or less of liquefied food at a time, but not enough to allow digestive juices to reflux into the stomach.
In cases of bile reflux, the valve doesn’t close properly, and bile washes back into the stomach. This can lead to inflammation of the stomach lining .
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How Is It Diagnosed
There are a few tests available in Europe that can help to diagnose BAM, but many arent available in the United States. However, according to the Mayo Clinic, two tests are now available for U.S. use, one for research purposes and the other clinical use:
- fasting serum C4, for research use only
- fecal bile acid test
The fecal bile acid test involves collecting stool samples over the course of 48 hours and examining them for signs of bile acid.
Keep in mind that this test still has limited availability in the United States, so your doctor may instead make a diagnosis by ruling out other conditions that might be causing your watery diarrhea, such as another type of malabsorption. They may even prescribe a medication used to treat BAM to see if it helps. If your symptoms start to improve with the medication, this may be enough to make a diagnosis.
Treatment for bile acid malabsorption usually focuses on medication and dietary changes. Most people with BAM find the best results by using a combination of the two.
In many cases of secondary BAM, treating the underlying condition can also eliminate symptoms.
Does Bile Acid Malabsorption Need To Be Monitored And If So How
Medications used to treat bile acid malabsorption do carry some side effects. This includes lowering the levels of fat soluble vitamins because the medications can disrupt the way these vitamins are absorbed into the body. In addition, these medications can be often used to help lower cholesterol but this can lead to an increase in different sorts of fats in the blood, namely triglycerides. Therefore, regular blood tests to monitor the levels of triglycerides and fat-soluble vitamins may be necessary whilst on the medication.
Weight loss can occur if diarrhoea is severe and it is important to monitor this. It may also be helpful to keep a note of stool frequency and consistency on a chart, as this can be used to inform the doctor as to how symptoms are controlled and doses of medication can be adjusted if needed.
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How Is Indigestion Treated
You should not have foods or medicines that cause indigestion. It is also helpful to avoid stressful situations. Your symptoms may feel better if you:
- Quit smoking
- Take medicines that weaken or neutralize stomach acid
Your healthcare provider may suggest you take medicines that:
- Help your stomach move food more quickly into your small intestine
- Kill bacteria if tests show you have the H. pylori bacteria in your stomach
- Help calm the gut’s nervous system
How Does Bile Reflux Affect My Body
Bile is composed of ingredients designed to digest fat. While it isnt an acidic formula, its harsh on the sensitive linings of your stomach and esophagus. Chronic bile reflux can erode these protective linings, causing painful inflammation and, eventually, tissue damage . Youll feel it as a burning kind of stomach ache, heartburn or sore throat, or as regurgitation of stomach contents into your esophagus. You may also have frequent nausea, indigestion or even bile vomit.
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How Is Bile Reflux Treated
Healthcare providers prescribe a variety of medications to treat bile reflux and its symptoms, but these have not been well studied. Youll have to see if they work for you. When they dont work, and your symptoms remain severe, your healthcare provider may recommend surgery.
Medications to treat bile reflux include:
- Ursodeoxycholic acid , which changes the content of bile in your stomach.
- Bile acid sequestrants, which bind and disrupt the circulation of bile.
- Sucralfate, which coats and protects the lining of your stomach and esophagus.
- Prokinetic agents to encourage motility between your stomach and small intestine.
- Baclofen, a medication that decreases the relaxation of your lower esophageal sphincter.
Surgical interventions to treat bile reflux include:
- Diversion surgery to direct bile away from the stomach.
- Anti-reflux surgery to strengthen and reinforce the lower esophageal sphincter.
What Are The Possible Complications Of Bile Reflux
Chronic inflammation of your stomach lining can lead to stomach ulcers and is associated with a higher risk of stomach cancer. Inflammation of your esophagus can cause ulcers, scarring and cellular changes to your lining , which is occasionally a precursor to esophageal cancer. These risks are also associated with chronic gastroesophageal acid reflux , but studies show that bile reflux multiplies the risk.
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Diagnosis Of Yellow Bile Reflux
Researchers have developed different methods to investigate reflux in the stomach and esophagus. But until now, no definitive diagnosis of reflux disease exists.
The first and easiest method of diagnosis is to detect the presence of bile and then measure it. When there is reflux, a biochemical analysis can be used to identify the presence of bile in the liquid that refluxed into the esophagus. Bile should not be in the esophagus, and its presence is a symptom of bile reflux.
What To Expect From Your Doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may give you time to go over points you want to spend more time on. You may be asked:
- What are your symptoms?
- How long have you had these symptoms?
- Do your symptoms come and go or stay about the same?
- If your symptoms include pain, where is your pain located?
- Have your signs and symptoms included vomiting?
- Does anything seem to trigger your symptoms, including certain foods or beverages?
- Have you lost weight without trying?
- Have you seen a doctor for these symptoms before?
- What treatments have you tried so far? Has anything helped?
- Have you been diagnosed with any other medical conditions?
- Have you had stomach surgery or had your gallbladder removed?
- What medications are you taking, including prescription and over-the-counter medications, vitamins, herbs and supplements?
- What is your typical daily diet?
- Do you drink alcohol? How much?
- Do you smoke?
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Surgery And Other Procedures Used If Medications Dont Help
Most GERD can be controlled through medications. In situations where medications arent helpful or you wish to avoid long-term medication use, your doctor may recommend more invasive procedures, such as:
Talk to your doctor about what alternative GERD treatments may be safe for you. Options may include:
- Herbal remedies. Herbal remedies sometimes used for GERD symptoms include licorice, slippery elm, chamomile and marshmallow. Herbal remedies can have serious side effects, and they may interfere with medications. Ask your doctor about a safe dosage before beginning any herbal remedy.
- Relaxation therapies. Techniques to calm stress and anxiety may reduce signs and symptoms of GERD. Ask your doctor about relaxation techniques, such as progressive muscle relaxation or guided imagery.
- Acupuncture. Acupuncture involves inserting thin needles into specific points on your body. One small study reported that acupuncture helped people with heartburn that persisted despite medication. Ask your doctor whether acupuncture is safe for you.
Causes Of Vomiting Bile
Vomiting bile can occur whenever a person throws up, and their stomach is empty. This can happen when someone has stomach flu or food poisoning and has already thrown up all the food in their stomach. It can also happen if a person has not eaten for many hours.
There is a range of other reasons why a person may throw up bile, including:
- binge drinking
- bile reflux
- intestinal blockage
While many cases of vomiting bile have a clear cause, vomiting due to an intestinal blockage or other condition may be more difficult to determine.
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Causes Of Heartburn And Acid Reflux
Lots of people get heartburn from time to time. There’s often no obvious reason why.
Sometimes it’s caused or made worse by:
- certain food and drink such as coffee, tomatoes, alcohol, chocolate and fatty or spicy foods
- being overweight
- some medicines, such as anti-inflammatory painkillers
- a hiatus hernia when part of your stomach moves up into your chest