Bile reflux

Hi All,

this is the first time im writing to everybody. I had total gastractomy 2.5 years ago and recent endoscopy showed bile reflux which explained my strange cough. There is no medication that can suppress or control bile reflux. since there are no sphincters (small intestine is connected to the esophagus), bile goes up. My understanding is that if bile is not under control, it will damage esophagus and that will be the beginning of the end. I'm trying to be optimistic, though. Question - is there anybody with the similar problem and how are you dealing with it? Thank you.

9 Replies

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  • Can you not have your bile duct removed so stopping the production of bile? I am hoping it is not the beginning of the end as I suffer bile reflux 7 months after my operation.

    Why'll be watching the replies in this post & hope you get positive news.

  • Thank you, Zantri! I read that liver produces bile and sends it to gallbladder where it is stored until (raw) food comes into the intestine. Bile helps to digest especially fatty foods. I'm not a doc, but not sure removing the gallbladder will solve the problem, however, I also thought about it and will ask ge/oncologist in the end of April and then let you know.

  • I have had my gallbladder removed and I can assure that that makes the problems very much worse.

    Fresh,un-aged, un-dewatered, un-concentrated bile flows continuously into the duodenum with the result that there is less capability to deal with fats, together with almost certainly, chronic diarrhea.

  • Unfortunately not. Bile is produced inexorably in the liver as part of the process of removing stale haemoglobin (oxygen-carrying pigment in the red blood cells). It has to go somewhere otherwise there are major problems.

  • Hi there,

    Thank you for your response. How are you dealing with this ?

  • Hi

    am 78 and had a total gastrectomy coming up 5 years in June and have always suffered with bile reflux. I had my gall bladder removed a couple of years beforehand and makes no difference with this out. I am on 2 x 20mg daily Omeprazole and 3 x daily 10mg Domperidone that is supposed to help but I still get it. Most days I have a pain in the oesophagus and feel sick but am not then other days I can be reaching a lot of the day, very frustrating. I still have problems swallowing food and drink as can be painful and often regurgitate the first couple of mouthfuls, strange as doesn't happen all the time. I also have bile reflux at night used to be every night but nowadays only a couple of times a week. In addition I get a pain right across the chest that I am told is a spasm and whilst this is often after eating I do get them when I am not probably have these once a week and could do without them?. Generally I guess I am okay in as much still here and surviving, I make the same comments each time I see my upper GI specialist nurse and am told they are things I have to live with. What I have started doing is keeping a note of what I am eating so can try and determine if it is something triggering bile or these spasms, like dairy maybe, something I should have done a long time ago. I have had endoscopies over the years the last one was 31st August 2016 and oesophagus was normal so not the beginning of the end yet.

    I think each persons issues are individual as I know another guy who has had a total gastrectomy and doesn't suffer with the swallowing issues or eating pains that I do however he does have dumping syndrome. I will be interested in how you get along though as don't know too many total gastrectomy patients can let you have my e-mail if want

    best regards

    Rob

  • Hi Rob,

    5 years!!! Great. It's seems you are getting a little better each year. Of course, please give me your email. I don't know either too many ppl with total gastractomy. I do have dumping syndrome as well, though it's getting better now as I'm learning what to eat / not to eat.

    Omeprazole should work for stomach acid. Not sure it's useful in our case.

    I also have irritation in small intestine from bile and started taking Carafate that works to protect intestines from bile and prevent ulcers in intestines- the pill is huge and I can't swallow it, so I make powder out the pill first and take it before food. It seems the digestion goes easier and smother.

    I raised the headboard of the bed and put pillows so I'm sleeping almost sitting ....otherwise bile comes up

    I read that two glasses of very warm (almost hot) water can wash off bile when it goes up.

    There is another thing that I found extremely difficult- I have to constantly go from one doc to another to get answers.

    If you have bile reflux at night - do you think it's because you are Hungry or went to bed right after eating?

    Stay well

    Alisa

  • You are right that bile reflux (alkali) is not combatted by PPI medication that is designed to switch off stomach acid when you no longer have a stomach.

    Gaviscon is an alginate that creates a protective raft that should work against bile, but only for a few hours.

    I understood that cholestyramine can help sometimes with bile. I believe that a roux-en-y procedure diverts the bile further down the system in gastrectomy cases but obviously the details are different for each person.

    I think it is fair to say that prolonged reflux might tend to damage the lining of the oesophagus regardless of whether it is bile or acid, and that reflux can cause persistent coughing.

    I think this is a significant problem that would need a specialist answer, either from your original surgery team or from an experienced gastroenterological colleague. It is a problem of re-balancing the system in relation to these strong chemicals that naturally occur in the digestive system but cause problems if they get into the wrong place. Everything one changes in the system is liable to have some kind of secondary effect, not least on your gut flora, and you need to sit down with an experienced specialist, or even ask for a second opinion, to work out what the optimum course of action (or inaction) should be.

  • Logic says that if bile was a major factor in inducing metaplasia then Barretts then cancer at the gastro-easophageal junction, or above, then it is equally likely to have the same effect upon what is left of our gullets after the pull up.

    Unhappily none of us has survived long enough to see if this hypothesis is true!

    But some researchers are beginning to look for it.

    Hence the need to minimize reflux at all costs.

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