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Biliary reflux, bile reflux (gastritis), 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.[1][2]

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 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 duodenum after food is ingested the 1 last update 04 Jun 2020 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.[3] Bile reflux has been associated with gastric cancer, chemical gastritis and the development of ulcers.[4] Bile is a digestive fluid made by the liver, stored in the gallbladder, and discharged into 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.[3] Bile reflux has been associated with gastric cancer, chemical gastritis and the development of ulcers.[4]

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Symptoms[edit][edit]

Heartburn Remedies Natural Heartburn Remedies (👍 Holiday) | Heartburn Remedies 6 Ways To Get Relief Duringhow to Heartburn Remedies for Bile reflux can be asymptomatic when laying down or after eating, as bile reflux occurs physiologically.[4]

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Bile reflux gastritis can result from excess bile in the duodenum, lack of a pylorus as a barrier to retrograde flow, and/or decreased anterograde peristalsis of the stomach and duodenum. This can occur following gastric or biliary surgery or as primary biliary reflux. The most common predisposing surgeries are those that either remove, disrupt or bypass the pylorus, resulting in unopposed reflux of duodenal contents. Primary biliary reflux occurs in the absence of gastric surgery. Risk factors include gallbladder dysfunction and gastric or duodenal dysmotility.[5]

Epidemiology[edit]

Obesity is an independent risk factor for development of bile reflux.[1] Bile reflux is very infrequent in healthy individuals.[6]

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At this time, whilst no gold standard exists, cholescintigraphy HIDA scan, is the least invasive investigation with good-patient tolerability, sensitivity,and reproducibility to be considered first-line for diagnosis of bile reflux.[1] An unpractical diagnosis method consists of identifying esopha-geal content when there is reflux, to test the presence of bile in the liquid that refluxated into the esophagus. Bile should not be in the esophagus; the presence of bile indicates the presence of bile reflux. Another method is the Bilitec monitoring system, it helps identify changes in the color of the refluxate in the esophagus. Because bile has a specific color range, this photo-colorimetric device enables a physician to determine whether there is bile in the refluxate and, if so, how much and for how long it was in the esophagus.[6] Bile reflux is usually associated with:

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