Symptoms and Causes
Both acid reflux and bile reflux may afflict the same person, which can make diagnosis a challenge. But the stomach inflammation that results from bile reflux often causes a burning or gnawing pain in the upper abdomen that is not felt with acid reflux, according to experts at the Mayo Clinic. Other symptoms of bile reflux may include frequent heartburn (the main symptom of acid reflux), nausea, vomiting bile, sometimes a cough or hoarseness and unintended weight loss.
A brief anatomy lesson makes the problem easier to understand. The main organs of the digestive tract are separated by valvelike tissues that, when functioning properly, allow food and digestive fluids to pass in only one direction: down. Thus, as food and liquids pass through the digestive process, they normally travel from the mouth to the throat, then down the esophagus into the stomach, and finally into the small intestine. The opening between the esophagus and stomach, a muscular ring called the lower esophageal sphincter, is meant to keep stomach acid from backing up. When it malfunctions, acid reflux — chronic heartburn — is the usual result.
Likewise, the pyloric valve, the muscular ring between the stomach and small intestine, is supposed to open just enough to permit a fraction of an ounce of liquefied food to pass into the small intestine, but not enough to allow bile to back up into the stomach. When this valve fails to close properly, refluxed bile can cause gastritis, an irritation and inflammation of the stomach lining. Untreated, that can result in a bleeding ulcer or even stomach cancer.
If the esophageal sphincter malfunctions at the same time, or there is a build-up of pressure in the stomach, bile and acid can reach the lower portion of the esophagus, inflaming the delicate lining of this organ. If the problem persists, it can cause scarring that narrows the esophagus, which may result in choking, or the cellular abnormality called Barrett's esophagus, which can become precancerous and eventually develop into cancer that is nearly always fatal.
Gastroenterologists have recently demonstrated that Barrett's esophagus can often be effectively treated with radiofrequency therapy, which might help patients like Mrs. Kozma.
Bile reflux can occur as a complication of certain surgeries, like the gallbladder surgery Mrs. Kozma underwent. More often, though, damage to the pyloric valve results from gastric surgery — total removal of the stomach or the gastric bypass operation used to treat morbid obesity.
Occasionally, the pyloric valve is obstructed by a peptic ulcer, for example, or scar tissue, which prevents the valve from opening enough to permit quick transport of stomach contents into the intestine. That causes pressure to build up in the stomach, pushing both acid and bile into the esophagus.