bile reflux management

[elenifoscolos]

Hi everyone... I would like some advice - after 10 years of reflux, and 8 years on ppi's which controlled my symptoms, suddenly I have a metallic taste in my mouth, which also feels like burning, and so does my throat. I had severe esophagitis 8 years before, but since then, after 5 endoscopies, I have no esophagitis and I did not ever have barretts. My doctor suggests that it is bile reflux, but did not pay much attention to it. Are there any drugs available which manage bile reflux? Also, should I ever repeat an endoscopy since I have no barretts? (44 years old, not obese, no smoking, no alcohol). Thank you for the help!!

[HONORIUS]

Always err on the side of caution. I was told for 18 months that my reflux was the result of Hiatus Hernia: it wasn't. If in doubt, push for an endoscopy. It's a vile procedure but it could save your life. As regards controlling the reflux, readers of this forum will know what's coming next from me: I advocate Tung acupuncture. After my Ivor Lewis in June 2015, every night was plagued with bile reflux, which disrupted my sleep and caused massive build-up of phlegm. As I was concerned about the adverse long-term effects of PPIs, I was advised to try Tung acupuncture (NB: the Tung element is vitally important) and in March of this year I did so. I have had no bile reflux since. This can't be psychosomatic: I have no pyloric sphincter. However, I remain bile-free, even though I wake up most mornings lying flat on my back having wormed my way out of the Princess and The Pea mound of pillows that have been a fixture on the bed since my procedure. It works for me.

[Hidden]

One of the medications that might be used is cholestyramine, but it needs investigation as to why you are having the bile reflux if this is persistent, and this might mean an extra endoscopy. It could be something to do with the bile duct perhaps. The bile can irritate the oesophagus just as much as acid. There is something called impedance monitoring that can test whether you are suffering from acid or bile. It is a balance between acid and alkali in your system. Gaviscon should work to some extent against either, because it is an alginate that creates a protective raft. Antacids will not affect the alkali, and might make it worse. If you give up the PPIs you might get a 'bounce' effect for a couple of weeks, but after a long period on PPIs it would be worth reviewing these with your doctor anyway to see if they are still effective and whether you still need them. But the doctors would need to know which one (or conceivably both) you are suffering from in order to consider the right medication.

[gutlesswonder]

Is your period of suffering 10+ 8 = 18 years overall?

How long ago was your last endoscopy? If it was sufficiently long ago then it is possible that some degree of displasia (the first discernible changes in the lining cells which can progress on to Barrett's) may have occurred.

If this is a possibility then a fresh scoping is indicated.

I was 47 when I needed an Ivor Lewis gastro-eosophagectomy!

There is not an effective antidote to bile in the eosophagus and above, but elevating the bedhead legs 8-10 inches should prevent most night time incidents of reflux.

Cholestyramine only serves to passivate excess bile acids from inducing diarrhea further down in the large intestine, it has little or no relevance in regards to reflux.

[elenifoscolos in reply to gutlesswonder]

Thank you very much for all comments and help.. My period of suffering is 10 years (3 without medication and 7 on ppis..). My last endoscopy was July 2015 and no barretts was found, as in all previous ones.. My doctor proposed Gaviscon at night but it does not affect my burning mouth and throat. However, i have no other symptom (stomach, chest etc) - but if i stop ppis, i will certainly have..