Bile reflux can be difficult to distinguish from gastric acid reflux. The signs and symptoms are similar, and the two conditions may occur at the same time.

Bile reflux signs and symptoms include:

• Upper abdominal pain that may be severe
• Frequent heartburn — a burning sensation in your chest that sometimes spreads to your throat, along with a sour taste in your mouth
• Nausea
• Vomiting a greenish-yellow fluid (bile)
• Occasionally, a cough or hoarseness
• Unintended weight loss

Bile is a greenish-yellow fluid that is essential for digesting fats and for eliminating worn-out red blood cells and certain toxins from your body. Bile is produced in your liver and stored in your gallbladder.

Eating a meal that contains even a small amount of fat signals your gallbladder to release bile, which flows through two small tubes (cystic duct and common bile duct) into the upper part of your small intestine (duodenum).

Bile reflux into the stomach

Bile and food mix in the duodenum and enter your small intestine through the pyloric valve, a heavy ring of muscle located at the outlet of your stomach. The pyloric valve usually opens only slightly — enough to release about an eighth of an ounce (about 3.5 milliliters) of liquefied food at a time, but not enough to allow digestive juices to reflux into the stomach. In many cases of bile reflux, the valve doesn't close properly, and bile washes back into the stomach. This can lead to inflammation of the stomach lining (bile reflux gastritis).

Bile reflux into the esophagus

Bile and stomach acid can reflux into the esophagus when another muscular valve, the lower esophageal sphincter, malfunctions. The lower esophageal sphincter separates the esophagus and stomach. The valve normally opens just long enough to allow food to pass into the stomach. But if the valve weakens or relaxes abnormally, bile can wash back into the esophagus.

What leads to bile reflux?

Bile reflux may be caused by:

• Surgery complications. Gastric surgery, including total removal of the stomach (gastrectomy) and gastric bypass surgery for weight loss, is responsible for most bile reflux.
• Peptic ulcers. A peptic ulcer can block the pyloric valve so that it doesn't open enough to allow the stomach to empty as quickly as it should. Stagnant food in the stomach can lead to increased gastric pressure and allow bile and stomach acid to back up into the esophagus.
• Gallbladder surgery (cholecystectomy). People who have had their gallbladders removed have significantly more bile reflux than do people who haven't had this surgery.

Bile reflux gastritis has been linked to stomach cancer. The combination of bile and acid reflux also increases the risk of the following complications:

• GERD. This condition is most often due to excess acid. Although bile has been implicated, its importance in gastric acid reflux is controversial.
• Barrett's esophagus. This serious condition can occur when long-term exposure to stomach acid, or to acid and bile, damages tissue in the lower esophagus. The damaged esophageal cells have an increased risk of becoming cancerous. Animal studies have also linked bile reflux to the occurrence of Barrett's esophagus.
• Esophageal cancer. This form of cancer may not be diagnosed until it's quite advanced. The possible link between bile and acid reflux and esophageal cancer remains controversial, but many experts think a direct connection exists. In animal studies, bile reflux alone has been shown to cause cancer of the esophagus.