Biliary reflux
{{Short description|Abnormal flow of intestinal contents into the stomach and esophagus}}
{{Technical|date=August 2024}}
Biliary reflux, also called bile reflux, duodenogastroesophageal reflux (DGER) or duodenogastric reflux, is a condition that occurs when bile and/or other contents like bicarbonate and pancreatic enzymes flow upward (refluxes) from the duodenum into the stomach and esophagus.{{cite book|last1=Cheifetz|first1=Adam S.|last2=Brown|first2=Alphonso|last3=Curry|first3=Michael|author4=Alan C. Moss|title=Oxford American Handbook of Gastroenterology and Hepatology|url=https://books.google.com/books?id=UbX-6Qbj--0C&pg=PA239|access-date=2 August 2011|date=2011-03-10|publisher=Oxford University Press US|isbn=978-0-19-538318-8|pages=239–}}
Biliary reflux can be confused with acid reflux, also known as gastroesophageal reflux disease (GERD). While bile reflux involves fluid from the small intestine flowing into the stomach and esophagus, acid reflux is the backflow of stomach acid into the esophagus. These conditions are often related, and differentiating between the two can be difficult.
Bile is a digestive fluid made by the liver, stored in the gallbladder, and discharged into the duodenum after food is ingested to aid in the digestion of fat. Normally, the pyloric sphincter prevents bile from entering the stomach. When the pyloric sphincter is damaged or fails to work correctly, bile can enter the stomach and then be transported into the esophagus as in gastric reflux. The presence of small amounts of bile in the stomach is relatively common and usually asymptomatic, but excessive refluxed bile causes irritation and inflammation.[http://www.mayoclinic.org/medical-edge-newspaper-2011/aug-05b.html Distinguishing Between Bile Reflux and Acid Reflux can be Difficult]
Bile reflux has been associated with gastric cancer, chemical gastritis and the development of ulcers.
Symptoms and signs
- Frequent heartburn
- Pain in the upper part of the abdomen
- Vomiting and/or regurgitating bile
- Hypersalivation
Bile reflux can be asymptomatic when lying down or after eating, as bile reflux occurs physiologically.{{cite journal |vauthors=Mabrut JY, Collard JM, Baulieux J | title = [Duodenogastric and gastroesophageal bile reflux]. | journal = Journal de chirurgie| volume = 143 | issue = 6 | pages =355–65 | date = 2006 | doi = 10.1016/s0021-7697(06)73717-6 | pmid =17285081 }}
Diagnosis
Bile reflux is usually associated with:
- Erosive esophagitis
- Barrett's esophagus
Management
Ursodeoxycholic acid is an adequate treatment of bile reflux gastritis. The dosage is usually of:
Adult(body-weight 47kg and above): 250mg once daily for 10-14 days, dose to be taken at bedtime. BNF 84 (British National Formulary)
=Surgery=
Biliary reflux may also be treated surgically, if medications are ineffective or if precancerous tissue is present in the esophagus.{{Cite web | url=http://www.mayoclinic.org/diseases-conditions/bile-reflux/basics/definition/con-20025548 | title=Bile reflux - Symptoms and causes | website=Mayo Clinic }}
Epidemiology
Obesity is an independent risk factor for development of bile reflux.{{cite journal |vauthors=Eldredge TA, Myers JC, Kiroff GK, Shenfine J | title = Detecting Bile Reflux-the Enigma of Bariatric Surgery. | journal = Obes Surg | volume = 28 | issue = 2 | pages =559–566 | date = 2018 | doi = 10.1007/s11695-017-3026-6 | pmid =29230622 | s2cid = 6118821 }}
Bile reflux is very infrequent in healthy individuals.{{cite journal |vauthors=Sifrim D |title=Management of bile reflux |journal=Gastroenterol Hepatol (N Y) |volume=9 |issue=3 |pages=179–80 |year=2013 |pmid=23961269 |pmc=3745208 }}
Bile acids are frequently present in the gastroesophageal refluxate, and thus can cause inflammatory and neoplastic changes in the upper aerodigestive tract.{{cite journal |vauthors=Vageli DP, Doukas SG, Doukas PG, Judson BL |title=Bile reflux and hypopharyngeal cancer (Review) |journal=Oncol Rep |volume=46 |issue=5 |pages= |date=November 2021 |pmid=34558652 |pmc=8485019 |doi=10.3892/or.2021.8195 |url=}} Bile reflux appears to be a causal factor in human hypopharyngeal squamous cell carcinoma.{{cite journal |vauthors=Sasaki CT, Doukas SG, Costa J, Vageli DP |title=Biliary reflux as a causal factor in hypopharyngeal carcinoma: New clinical evidence and implications |journal=Cancer |volume=125 |issue=20 |pages=3554–3565 |date=October 2019 |pmid=31310330 |doi=10.1002/cncr.32369 |url=}} In a mouse study it was shown that acidic bile refluxate causes oxidative DNA damage leading to progressive mutagenic effects and hypopharyngeal squamous cell carcinogenesis.{{cite journal |vauthors=Sasaki CT, Doukas SG, Costa J, Vageli DP |title=The Progressive Mutagenic Effects of Acidic Bile Refluxate in Hypopharyngeal Squamous Cell Carcinogenesis: New Insights |journal=Cancers (Basel) |volume=12 |issue=5 |date=April 2020 |page=1064 |pmid=32344873 |pmc=7281001 |doi=10.3390/cancers12051064 |doi-access=free |url=}}
References
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External links
- [https://www.nytimes.com/2009/06/30/health/30brod.html The damage of reflux]
- [http://www.cnn.com/HEALTH/library/bile-reflux/DS00651.html Bile Reflux page at CNN Health:symptoms, causes, diagnosis, treatment, prevention]