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Bile reflux: A vile torment

Bile reflux: A vile torment

Bile reflux is caused when bile is backed up into the stomach causing heartburn, bloating and many other symptoms

Bile reflux

“I used to curl up into C shape and sleep because of my unbearable tummy ache” says Saipriya Sivakumar, a Pune based 32-year-old techie. She has been battling an array of gastro and weight related issues with sheer grit and elegance. She has experienced both acid reflux and bile reflux. 

From 2008 to 2012 she suffered from severe acid reflux and gastric issues. She recounts to Happiest Health the multiple diet combinations she tried. But nothing worked. She went through several tests including endoscopy which confirmed acid reflux disease and deteriorating gallbladder function. In 2013, she had acid reflux surgery and gallbladder removal surgery. 


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A common complication of gallbladder removal surgery is bile leakage into the abdomen resulting in severe bile reflux. In 2020, Saipriya underwent weight management surgery and soon after she started having severe episodes of bile reflux. Initially she thought it was due to drastic changes in her regimented diet due to work schedule. But her doctor confirmed that it was because of her gallbladder removal. After digestion, bile leaked into the duodenum (initial part of the small intestine) and backed up into the stomach causing inflammation. 

What is bile reflux?

Bile is a fluid secreted by the liver that helps in digestion by breaking down fats. Ideally, it remains in the gallbladder when it’s not required and enters the small intestine during meals. Dr K. S. Soma Sekhar Rao, consultant gastroenterologist, hepatologist & therapeutic endoscopist, Apollo Hospitals, Hyderabad explains that when it leaks into the stomach, it is called bile reflux. He further adds that in extreme cases bile can come into the oesophagus (food pipe) as well.

Causes of bile reflux

Bile reflux is caused due to

  • Sedentary lifestyle 
  • Unhealthy food habits – intake of oily, fatty, and processed food
  • Hiatal hernia – a bulge at the junction of oesophagus and stomach that causes weakness of lower esophageal sphincter valve that helps control gastric reflux.
  • Factors like obesity, alcohol, and smoking

Symptoms of bile reflux

According to experts, the main symptoms of bile reflux include:

  • Heartburn
  • Throat discomfort
  • Voice changes
  • Bloating
  • Fullness
  • Nausea
  • Vomiting
  • Difficulty in swallowing
  • Belching

Acidity and acid reflux

Dr Rakesh Patel, Consultant Gastroenterology, Fortis Hospital, Mumbai, India says that scientifically the term “acidity” doesn’t exist. Many report the cluster of symptoms like heartburn, fullness, bloating, throat discomfort, swallowing difficulty and abdominal burning as acidity. However, clinically they may represent symptoms of different conditions like reflux disease, peptic ulcer (sores), dyspepsia (chronic indigestion) and irritable bowel syndrome.

Acid reflux is defined as the backward flow of stomach acid into the oesophagus. If chronic, then it is scientifically termed Gastroesophageal reflux disease or GERD.

Bile reflux vs acid reflux

Both conditions can manifest in the same person at different times. They also share common symptoms. But bile reflux could have more serious health complications.

“Bile reflux episodes approximately lasts for 10 minutes but don’t let me sleep for the next 3 or 4 hours because of the anxiety attached to its reappearance. Bile juice also used to leak out from my mouth and nose,” adds Saipriya.

She also suffered from a sore throat. “I end up having a man’s voice for a day,” adds Saipriya. She didn’t feel like eating anything spicy or oily and ate bland food like idli or dal rice.

Alternatively, acid reflux meant tummy ache, fullness, consistent heartburn, and indigestion. She recalls, “I used to throw up immediately if I ate a bit more than usual.” She points out, in acid reflux nothing used to suit her stomach, even something as mild as curd rice. Acid reflux episodes existed for a day or two whereas bile reflux is a 10 minute episode with long lasting impact like sore throat appearing for a day or two. 

Diagnosing reflux conditions

Experts say that it is almost impossible to differentiate between the symptoms of acid or bile reflux. They recommend consulting a specialist if the condition persists for one month after taking all precautionary and preventive measures including lifestyle alterations and medications. Research also indicates if severe and unmanaged, bile reflux can even be a risk factor for gastric cancer and precancerous lesions.

There are two invasive tests that help identify reflux diseases: Endoscopy and pH manometry. In endoscopy, a thin tube is inserted down the mouth into the stomach to examine the intestine and oesophagus. It helps identify the inflammation in the oesophagus and the volume of gastric content (acid, bile or both).

pH manometry determines if it’s an acid reflux or bile reflux. The person is hospitalised for this procedure. A tube with sensors at the lower end is passed through the nose into the oesophagus and assesses the content as acidic or non- acidic on the basis of pH level. Usually, the bile reflux shows high alkalinity. 

Things to keep in mind

Dr Patel recommends the following tips to keep acid and bile refluxes at bay

  • Stay active
  • Quit smoking and alcohol
  • Have more fruits and vegetables.
  • Eat less oily food
  • Timely food intake
  • Don’t eat and sleep immediately
  • See a doctor (if symptoms persist after 4 weeks)


Bile reflux and acid reflux are gastric conditions that could cause extreme discomfort. Experts point out that though acid reflux is more common, it is bile reflux that could be cause for concern. However bile reflux can be controlled with dietary and lifestyle alterations. But medical intervention may be required in some extreme cases.

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