REFLUX COUGH - Bile

[gutlesswonder]

Do you have a productive cough and the sputum looks like this?

The orangey colour is caused by Bilirubin pigment in Bile.

It indicates that the Pyloric/the Lower and the Upper Oesophageal Sphincters are not functioning correctly and are allowing material from the Duodenum up into the Stomach and thence into the Oesophagus - Throat - Lungs.

This presents a serious danger of aspiration pneumonia.

The caustic properties of Bile can lead to severe lung damage (together with other reflux components such as Stomach acid, Pepsin protein digestive enzyme and Pancreatic Juices).

If the aspirant contains virulent bacteria the resultant acute infection can be life-threatening. Twenty one per cent (21%) of sufferers do not survive.

[Minniemouse22]

Thank you for this..I always cough up that colour and often wondered why.I now wonder if there is anything anyone can do about this. I am back on Lansoprazole twice a day due to having more attacks but all of mine seem to fall into the silent reflux category. My GP seems unconcerned even though I've mentioned how badly my throat,ears and mouth burn and how my lungs can feel on fire too plus I get a terrible chest pain and residual cough after these attacks. Is there any medication other than PPIs ,Gaviscon etc that can help in this bile type attack?

[Hidden in reply to Minniemouse22]

Yes. You should have a test first to check that it is bile, and the doctor should investigate why this is happening because the underlying causes are always important.

It is a balance between acid and alkali, so anything that reduces the acid is liable to make the alkali worse. There are medications like cholestyramine that might help, but, as I say, you really need somebody medically qualified to sort out any medication to make sure that they do not fight against each other.

The PPIs and antacids work by reducing acid in your system by one method or another, but the alginates (like Gaviscon Advance) create a raft on the top of your stomach that should protect your oesophagus against either acid or bile reflux for a few hours.

[Cortex1]

When you say cough, you mean this is what’s coming up from your lungs/airways? Not like, cough and you kind of vomit from your stomach?

How would one know the difference between bile and acid?

[Cortex1 in reply to Cortex1]

I was hoping someone could tell...Please.

[gutlesswonder in reply to Cortex1]

The red colour of blood is due to the presence of an Iron-containing pigment called Haemoglobin in every blood cell. The function of this pigment is to bind to Oxygen and carry that vital substance to where it is needed throughout the body.

Red blood cells die after about 100-120 days and are removed by the Spleen and the Liver where the Iron is extracted and stored for recycling. The residue of former Haemoglobin without its Iron is called Bilirubin, which, because the molecule has changed shape, has an intense orange colour.

The Bilirubin is passed into and stored in the Gallbladder, from where it is squirted into the Duodenum whenever a meal containing fats is eaten. Its function there is to act as a detergent (Fairy liquid!) and assist in dispersing and digesting those fats.

If you see the strong orange colour, as above from my own Sputum (Mucus coughed up from the Lungs) then this is a certain indicator that Bilirubin is present and this can only come from Bile which can only come from the Duodenum below the Pyloric Sphincter of the Stomach. IE it is a guaranteed signal of Aspiration Reflux.

If you vomit and that is orangey then equally the colour is due to the presence of Bile with Bilirubin.

It is not hard to distinguish between regurgitation and expectorant.

Hydrochloric Stomach Acid, on its own without Chyme (partially digested food), has a clear blue-green colour.

Acidity/Alkalinity (pH) can be easily tested using Litmus paper. (readily available in the internet) since the orange colour alone will not tell you if there is also acid present, which could counteract the alkalinity of Bile.

[Cortex1 in reply to gutlesswonder]

Thank you for explaining!

[phil]

This only happens to me if I have eaten too late with fatty foods pastry chocolate and cheese.I now ensure I leave 3 hours before going to bed,good pillow support and a Gaviscon before going to sleep.

This always works for me and I agree that a Bile reflux is awful and damaging and should be avoided at all costs

Phil

[Mrtoad]

Having had an Ivor Lewis 16 years ago I only started to get bile reflux about 3 or 4 years ago. It always happened about 2am and as previous correspondents have said I would be more likely to get it if I had eaten a fatty meal sometime during the day, I'm also a chocaholic and biscuitholic so tended to have some of either in the evening or maybe when I went to bed (biscuit barrel under the bed)!! I had been prescribed Questran but despite tolerating it for a while it made no difference. About 6 weeks ago I had a particularly bad episode, the bile got in my lungs yet again and I struggled to breath, it was so bad that I was on the verge of calling an ambulance but as it had happened before but less severe and the pain had always eventually subsided I persevered and the pain did eventually go. However the aspiration had caused a lung infection which took over a month to clear up-continual coughing and phlegm for all that time. After 3 years of this regular occurrence I was determined to make a serious effort to eradicate this happening. Having a BMI of 21 I couldn't lose weight to try and cure it so I decided to change my eating habits. The biscuit barrel has gone , I no longer fill the fridge with chocolate and my daughter religiously makes me a smoothie every day containing all the essential fruit and vitamins that we need, I have also reduced my coffee intake. Now I realise that this may not work for everyone but I have to say that the transformation has been remarkable, I have not had a repeat since changing to this new regime so I would recommend that you try this.