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Old 09-08-2012, 09:38 AM   #1
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Bile Reflux vs Acid Reflux

After years of numerous ER visits for asthma and/or cardiac symptoms (always diagnosed as "not heart-related, and probably just acid reflux"), I was considering NF surgery for my GERD. However, a new doctor took one look at my most recent endoscopy and said "You are not really a candidate for NF surgery because you can see the real problem is not Acid Reflux, but Bile Reflux, which will not be helped by NF surgery!" I am currently on Pepcid before breakfast and lunch, and Dexilant before dinner, and also take DGL before meals and Gaviscon after meals. To counteract the bile, I have been drinking warm tea with a little bit of apple cider vinegar added during each meal. Does anyone else have ideas on how to keep the bile from refluxing back from the pyloric valve?? BTW, thanks to this health board, I have greatly increased my dose of vitamin D-3 in the hope of strengthening the LES and UES valves. Also, it is obvious that I need to eventually get off the PPIs, but cannot do this right now!

 
Old 09-08-2012, 04:09 PM   #2
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Re: Bile Reflux vs Acid Reflux

Can't help with your question but curious as to how your doc was able to diagnose that your issue was in fact bile reflux. I can understand bile reflux being an issue with gastritis but in the end doesn't surgery fix like fundoplication serve to tighten the LES and stop any acid or bile from refluxing into the esophagus?

I don't undertstand why it would matter if bile was the underlying issue or gastric acid by itself?

 
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Old 09-08-2012, 08:35 PM   #3
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Re: Bile Reflux vs Acid Reflux

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Originally Posted by Johnah View Post
Can't help with your question but curious as to how your doc was able to diagnose that your issue was in fact bile reflux. I can understand bile reflux being an issue with gastritis but in the end doesn't surgery fix like fundoplication serve to tighten the LES and stop any acid or bile from refluxing into the esophagus?

I don't undertstand why it would matter if bile was the underlying issue or gastric acid by itself?
The new doc looked at the color photos in the endoscopy report and saw the green colored bile . . . this is not acidic, and it backs up into the stomach through the pyloric valve from the small intestine. When I am really nauseated (and throwing up) I know if it is bile because it is green and really hurts the esophagus. The fact that my gall bladder (where much bile is normally produced) was removed about 12 years ago may compound this problem. If someone has more medical knowledge and finds this explanation wanting, please chip in! I can understand why an antacid, or especially a PPI, might help with ACID reflux, but my real question is this: Is there some way to keep the bile in the small intestine where it belongs??!! Or, once it is in the stomach, and something acidic is needed to neutralize it, are PPIs counter productive??!! I am trying small doses of ACV, which works sometimes, but definitely not all the time!

 
Old 09-09-2012, 05:34 PM   #4
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Re: Bile Reflux vs Acid Reflux

Definitely, your gallbladder removal could be playing a role in all this. Sounds like you need to make another appointment with your GI doctor to develop a new game plan.

Actually, some sources say PPIs can make bile reflux worse, because suppressing the acid can increase bile production.

About the only thing that seems to stop bile reflux is to take the bile salt, ursodeoxycholic acid, or certain drugs that decrease bile production.

 
Old 09-10-2012, 06:36 AM   #5
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Re: Bile Reflux vs Acid Reflux

Quote:
Originally Posted by toolongonPPIs View Post
The new doc looked at the color photos in the endoscopy report and saw the green colored bile . . . this is not acidic, and it backs up into the stomach through the pyloric valve from the small intestine. When I am really nauseated (and throwing up) I know if it is bile because it is green and really hurts the esophagus. The fact that my gall bladder (where much bile is normally produced) was removed about 12 years ago may compound this problem.
Thanks for the explanation , makes sense. I had a endo and there was no mention of bile so I take it this is not seen as an issue for me. Might ask the gastro guy about this next visit.

When I do some research on bile though the internet tells me it is acidic but I imagine the PPI's have no impact on it being from another source.

Last edited by Johnah; 09-10-2012 at 06:39 AM.

 
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Old 09-10-2012, 06:45 AM   #6
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Re: Bile Reflux vs Acid Reflux

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Thanks for the explanation , makes sense. I had a endo and there was no mention of bile so I take it this is not seen as an issue for me. Might ask the gastro guy about this next visit.

When I do some research on bile though the internet tells me it is acidic but I imagine the PPI's have no impact on it being from another source.
Actually, I was told that bile is basic, not acidic . . . . does anyone know the right answer?

 
Old 09-10-2012, 07:38 AM   #7
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Re: Bile Reflux vs Acid Reflux

I looked it up again and found more information that says it is basic, it neutralizes the acid from the stomach. Funny Wiki has two sets of info on it which doesn't seem to agree. Regardless it does appear to be basic the more I dug into it , that can burn the esophagus as well according to the information found. To bad we can't put links up for better understanding on this website.

 
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Old 09-13-2012, 02:25 PM   #8
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Re: Bile Reflux vs Acid Reflux

Quote:
Originally Posted by Johnah View Post
I looked it up again and found more information that says it is basic, it neutralizes the acid from the stomach. Funny Wiki has two sets of info on it which doesn't seem to agree. Regardless it does appear to be basic the more I dug into it , that can burn the esophagus as well according to the information found. To bad we can't put links up for better understanding on this website.
I understand a little better now: The right term for bile reflux is that it is alkaline, and therefor it requires acid to neutralize it!!! Acid reflux is just the opposite, and either needs an alkaline product (like old-fashioned Alka-Seltzer, I guess) to neutralize it, or a PPI to reduce the volume of acid entering the stomach. Acid reflux just bubbles up from the stomach into the esophagus, whereas bile reflux backs up from the small intestine through the pyloric valve into the stomach. With all the activity on this Health Board (and also the Digestive Disorders board) you would think the drug companies would have some better products for us!!

 
Old 09-13-2012, 03:58 PM   #9
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Re: Bile Reflux vs Acid Reflux

Hi everyone. I am almost positive I am dealing with bile reflux and gastritis as well. Had my gall bladder remove in July hoping it would resolve my issues, but not entirely. I am currently taking Carafate 3x's daily and Metamucil 2x's daily. Doing this allows me to eat normally (relatively bland and healthy diet, no soda, coffee, spicy or fatty foods, etc.) If I don't follow this routine I get really sick and it can take me a week to get back on track. Currently I am experiencing a red, raw throat with a little hoarseness with the burning sensation still in my stomach. (it feels like I have swallowed and entire box of Altoids because it is a cold burning sensation.) I have tried Prilosec and Prevacid with little success. Does Gaviscon work better? Perhaps even Slippery Elm? My GI pulled me off Questran (used only 1 month) because he thought that it would eventually be more harmful then help. Does sleeping at an elevation really help? Any advice is greatly appreciated.

 
Old 09-13-2012, 05:28 PM   #10
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Re: Bile Reflux vs Acid Reflux

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Originally Posted by Niki1980 View Post
Hi everyone. I am almost positive I am dealing with bile reflux and gastritis as well. Had my gall bladder remove in July hoping it would resolve my issues, but not entirely. I am currently taking Carafate 3x's daily and Metamucil 2x's daily. Doing this allows me to eat normally (relatively bland and healthy diet, no soda, coffee, spicy or fatty foods, etc.) If I don't follow this routine I get really sick and it can take me a week to get back on track. Currently I am experiencing a red, raw throat with a little hoarseness with the burning sensation still in my stomach. (it feels like I have swallowed and entire box of Altoids because it is a cold burning sensation.) I have tried Prilosec and Prevacid with little success. Does Gaviscon work better? Perhaps even Slippery Elm? My GI pulled me off Questran (used only 1 month) because he thought that it would eventually be more harmful then help. Does sleeping at an elevation really help? Any advice is greatly appreciated.
Your diet sounds good. My gallbladder was removed 12 years ago, and apparently this does lead to bile reflux (which I did not learn until a couple of months ago!!). I take Pepcid and Carafate before each meal and at bedtime. I take DGL before each meal, and Gaviscon about 20 minutes after each meal, and maybe at bedtime, too. We have the head of the bed elevated a little over four inches, and it definitely helps. (Your doctor may have prescribed Questran for elevated cholesterol, and fish oil might be a better choice). I am also taking high doses of D-3 (as suggested on this Board) in the hope of strengthening the LES and UES muscles.

Good luck and keep in touch!

 
Old 09-14-2012, 03:15 PM   #11
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Re: Bile Reflux vs Acid Reflux

Thank you! I was put on Questran to absorb any extra bile in the stomach, but my GI thought that Metamucil was safer. Talk to me about the DGL. Is this safe to use? Any weird side effects? I would much rather use herbals than rx's. Have you ever experienced the panic/anxiety that can occur with a flare up? :/ If so what works best for this?

 
Old 09-15-2012, 10:31 AM   #12
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Re: Bile Reflux vs Acid Reflux

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Originally Posted by Niki1980 View Post
Thank you! I was put on Questran to absorb any extra bile in the stomach, but my GI thought that Metamucil was safer. Talk to me about the DGL. Is this safe to use? Any weird side effects? I would much rather use herbals than rx's. Have you ever experienced the panic/anxiety that can occur with a flare up? :/ If so what works best for this?
DGL is a licorice-based product which I think coats the stomach lining. DGL stands for deglycyrrhezinated licorice, available in heath food stores. I take one chewable lozenge about 20 minutes before each meal. I use the gaviscon after eating, because it is supposed to create a foamy layer to keep the food from backing up through the esophagus. Elevating the head of the bed, while not a complete cure, definitely helps! For anxiety/panic attacks my internist prescribed Lorazepam 0.5 mg three times a day . . . which does take the edge off somewhat. You have to find ways to talk yourself through the anxiety . . . walking helps me (probably aids with digestion, too!), reading, good music, etc. It is a pain, but I have to watch everything I eat . . . and this is especially difficult because PPIs seem to cause headaches for many people (like migraines in my case) so I am also on a special diet to eliminate foods which might trigger migraines. BTW, using metamucil to absorb bile in the stomach sounds like a good idea, so I will be giving that a try . . . keep in touch!

Last edited by toolongonPPIs; 09-15-2012 at 10:38 AM.

 
Old 09-17-2012, 12:27 PM   #13
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Re: Bile Reflux vs Acid Reflux

Has anyone ever tried using digestive enzymes? Do they work? Any weird side effects?

 
Old 09-17-2012, 05:56 PM   #14
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Re: Bile Reflux vs Acid Reflux

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Originally Posted by Niki1980 View Post
Has anyone ever tried using digestive enzymes? Do they work? Any weird side effects?
I have not, but would like to try digestive enzymes. I do take probiotics, which should help maintain a balance of good bacteria in the gut.

 
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