Oesophageal Patients Association
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Bile reflux?

I'm 7 months post gastrectomy and about a week ago I was awakened by a horrible burning like heartburn in my throat. As I don't have a stomach I assumed this was bile reflux - the first time I'd ever experienced it. Then this morning I've woken up to the delightful sight of a bright yellow patch on my pillow that smells faintly of the Worcester sauce crisps I had before bed. Lovely. Just wondering I'd this is normal as it seems a little coincidental to have my first ever two episodes of this within 6 days of each other. Could there be something sinister or otherwise going on that could cause this? Any experiences gratefully received as always

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Hi gwood,

I had total gastractomy 3 years ago. Docs recommend to wait 2 hours after last meal before you go to bed and raise headboard by 6 inches. (I sleep almost sitting and ware neck collar that holds my head). Bile damaged lower part of my esophagus (metaplasia), so they recommend to take carafate (2-3 Times a day) just to protect damaged tissue as there is nothing else that can suppress bile reflux or neutralize it.

You should also avoid eating food that Stimulate excessive bile secretion.

I hope you will find this helpful.

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Bile does tend to taste really foul, and I accept the logic that if you do not have a stomach it is much more likely to be bile reflux. But it is an assumption and the doctor might want to give you a test to be on the safe side as there is an acid:alkali balance to take into account. Some people find that cholestyramine can be helpful against bile reflux.

Did you slip down from your pillows in the night? Sometimes sleeping flatter can cause this sort of thing.

Have you had any changes to your eating regime, medication or felt anything different in the past week? Is your digestion otherwise working up to its new normal standard? Do you have any adverse effects during the daytime when you are upright?

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Well, I don't know how to break this to you. Your late night fry-ups may have gone by the wayside. Elevate your bed at the headboard. Pillows will not do as they bend you in the middle. Sleep on your left side only. Or...get floral pillow slips to blend with your new yellow late nite surprise art work on your bed clothes.

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Or find someone across the pond (U.S.A.) with six hour difference, to talk you through this new development 🏖

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Hi gwood,

I am seven years post op. and have noticed that crisps are one of the worst things to eat before bedtime.

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If you had the standard Ivor Lewis gastro-eosophagectomy you DO still have a 'stomach' !

Your original stomach was removed then cut and opened into a flat sheet; that flat sheet was then rolled and stitched into a tube. That tube is then sewn back to bridge the gap and replace the portion of the eosophagus which contained the carcinoma and had to be removed.

The significance of this is that you now have a tube, not a large bag (think bagpipes--sheep's stomach) so the capacity is tiny. Secondly the new tube is composed of stomach tissue and hence retains all or most of the original secretory functions for acid/hormones/pepsin etc.

The extent to which all these substances continue to be produced depends on how many nerve connections were severed during the surgical procedure and how much of the original stomach tissue could be preserved by the surgeon whilst cutting back a safe margin from the contaminated cancerous area. This means that every operation is unique in that every tumour is different and the technique of the surgeon varies.

healthunlocked.com/oesophag...

As a result of all this reflux is an horrible cocktail and quite variable in it's constituents; an orange colour simply confirms the presence of bile but not any of the other highly irritant chemicals.

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This does sound like bile. I had exactly the same problem for 4 years. I started eating Indian curry and I have been bile free ever since. It does get boring but I eat ordinary food during the day, then have curry at night. I have been able to sleep right through since.

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Thanks for the replies everyone.

Believe it or not since my gastrectomy stuff like crisps and chocolate is the easiest way for me to get calories and I'm pretty fortunate in that they don't cause me issues. Every night for about 4 months now my supper has been a toffee crisp and a packet or two of crisps. I also don't have any issues normally sleeping, and just use one extra pillow.

I have been experiencing some pain in my back/side over the past fortnight (which is causing me a lot of anxiety) so I've been referred for a ct scan. I mentioned the bile thing to my doctor and she didn't seem to bother much about it. If it keeps occurring ill change my supper habits and be more forceful with the doc in regards to getting to the bottom of it.

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There is an internet page about testing pH ie acid:bile that might be useful:

"How to test your pH

Knowing your pH balance can be important in pinpointing whether an imbalance in alkalinity is causing your digestive tract to perform poorly leading to heartburn issues. A healthy blood pH is a level of 7.36 to 7.45. Different areas of the body have different pH levels. For instance a normal pH for the stomach will be between 1 and 3.

We can easily test our saliva and urine with alkalinity strips that can be found at your local pharmacy. All you do is activate the strip with your fluid and compare the reading to the chart on the strip’s container. A healthy pH level measured by saliva is in the 7 to 7.4 range. To test saliva, you can spit on the strip. Try measuring your level first thing in the morning before drinking anything or brushing your teeth or two hours after eating or drinking anything. Urine pH levels should be 6 to 7. It will be on the more acidic end (lower number) in the morning and higher pH in the evening. Urine can be tested by urinating on the strip.

Because of variances in our bodies and diets, it will take a week or more of testing to get a good idea of your level. Continue testing daily if your levels aren’t in a proper range. This will help you understand how to adjust your diet and consume more alkaline foods for proper balance."

This comes from the website here:

howtotreatheartburn.com/is-...

which is not really designed for people who have had serious surgery to their oesophagus or stomach, but the content might be useful.

There is also a link to Qimius test strips here: amazon.co.uk/dp/B01M8QW6Z8/...

I do not know how good these are, but some may find it worth a try.

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Thanks for the info Alan. I've ordered those strips

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