People who suffer from acid reflux are faced with several problems. At times, the digestive fluid produced by the liver (known under the name “bile”) enters the stomach and esophagus from the small intestine and causes irritation. As this condition can occur at the same time with the reflux of gastric acid, the lining of the esophagus suffers from a double assault posing a greater risk of complications.

The symptoms of bile reflux are very similar to those present in cases of simple acid reflux. This makes distinguishing between the two conditions difficult, especially in situations when both are present. The main symptom characteristic to a case of bile reflux is the presence of a burning or biting pain in the upper abdomen, which indicates an inflammation of the gastric lining caused by bile.

Apart from the above, bile reflux is characterized by symptoms such as nausea, frequent heartburn, vomiting bile, occasional coughing and croakiness.

Paired with acid reflux, bile reflux can cause a number of complications including, but not limited to gastritis, gastroesophageal reflux disease, Barrett’s esophagus, esophageal stricture or even esophageal cancer.

Gastritis is an inflammation and irritation of the gastric lining, which may further progress into gastric ulcers, gastric bleeding and an increased risk of gastric cancer. Gastroesophageal reflux disease or GERD is a condition characterized by chronic acid reflux which may further develop into esophagitis. Barrett’s esophagus is caused by long term exposure of the esophageal tissue to gastric acid and bile; this may cause the tissue in the lower esophagus to change its composition and color. While the new cells have an increased resistance to the effects of bile and gastric acid, they also have a greater chance of becoming cancerous. An esophageal stricture may appear as a result of the formation of scar tissue in the lower esophagus when the tissue is exposed frequently to bile and gastric acid; the stricture, a narrowing of the esophageal passage, may cause the patient to have trouble swallowing and to be more prone to choking. Esophageal cancer is one of the most severe complications, and it may occur anywhere within the esophageal tract as a result of prolonged and extended exposure of the tissue to bile and gastric acid.

The typical treatment for patients suffering from both acid reflux and bile reflux simultaneously is based on the administration of proton pump inhibitor medication, which will block the production of gastric acid and sometimes may alleviate the effects of the bile reflux. Also, health care specialists may choose to prescribe ursodexycholic acid, a substance which helps return the bile flow to normal. Other drugs can be prescribed as well, based on the particularities of the case.

In some cases, bile reflux and acid reflux may need to be treated separately, as the bile reflux can only be controlled through medication or, in severe cases, through surgery. Even so, patients may still experience this condition even after the completion of the treatment.