Every day, the fiery sensation that comes with gastroesophageal reflux disease (GERD) sends one in five uncomfortable Americans to the pharmacy in search of relief. For some, an over-the-counter or prescription drug puts out that fire, but for a surprisingly large subset of sufferers, these drugs offer no relief. In some cases, that’s because another disorder is lurking silently in the background: bile reflux.
GERD vs. bile reflux
In GERD, acidic fluid from the stomach flows up through a weakened esophageal sphincter into the throat. But in bile reflux, bile travels from the small intestine, through a weakened pyloric valve, into the stomach. For people who have bile reflux without GERD, symptoms can include abdominal pain, nausea, vomiting, heartburn, and unintended weight loss.
In a person with GERD, however, the bile continues its journey into the esophagus along with the stomach acid. While medications such as antacids, proton-pump inhibitors (PPI), and H-2-receptor blockers can neutralize the acid, they do nothing to stop the burn of bile.
If you have GERD that doesn’t respond to treatment, especially if you’ve had your gallbladder removed or suffer from diabetic enteropathy, a digestive issue that may be associated with prediabetes or diabetes, it’s time to consider the possibility of bile reflux. Not only can it make GERD treatment difficult, but studies also suggest that bile can be more damaging to the lower esophagus, increasing the risk of Barrett’s esophagus, a long-term complication of GERD and possibly precancerous changes and cancer of the esophagus.
Treating bile reflux
There are no standard treatments for bile reflux, but many patients find relief with a multi-pronged approach.
Reduce pressure. When pressure below the diaphragm is high, it tends to move things upward. There are several ways to lower that pressure, such as doing simple breathing exercises and not holding your breath when exerting yourself or having a bowel movement.
Some people also benefit from treating underlying small intestine bacterial overgrowth (SIBO), a condition in which normally friendly bacteria overgrow in the intestine. As those bacteria convert carbohydrates into gas, it can increase abdominal pressure. Diarrhea or constipation, abdominal pain, distension, or bloating, and an uncomfortable feeling of fullness all suggest the possibility of SIBO.
People with this condition often have good results by following a low-fermentation diet, which is designed to deprive the bacteria of their preferred food source, fermentable carbohydrates, such as grains, beans, starchy vegetables, seeds, legumes, fruits and fruit sweeteners, agave, roots, and herbs. Visit http://www.siboinfo.com for details on the SIBO diet.
Improve the composition of the bile. Some research suggests that ursodiol (URSO, Actigall), a prescription bile salt, and tauroursodeoxycholic acid (TUDCA), an over-the-counter (OTC) bile acid, can make bile less irritating to the esophagus. For people with bile sludge, a mixture of mucus and particulate matter that forms in bile, OTC lecithin and N-acetyl cysteine can help the bile flow. The dosages of these supplements are highly individualized, so it’s important to work with a specialist who is familiar with bile reflux before taking them.
Strengthen the pyloric and esophageal sphincters. Huperzine A, an OTC extract, can boost levels of acetylcholine, a neurotransmitter that promotes good muscle tone in those valves. Further, mindfulness and relaxation techniques can strengthen the vagus nerve, which plays an important role in controlling muscles in the digestive tract. Strategies like alternate nostril breathing and therapeutic gargling may also strengthen the vagus nerve.
Protect and bolster the mucous membrane. Several medications can help the mucous membranes of the stomach and esophagus better withstand irritants. These include agents that form a soothing film, called demulcents, such as deglycyrrhizinated licorice, aloe vera, and a prescription called sucralfate (Orafate, ProThelial, Carafate).