Bile reflux happens when the digestive liquid produced in the liver called bile refluxes or backs up into the stomach and the esophagus.

Bile is a greenish-yellow fluid essential for digesting fats and removal of old red blood cells and particular toxins from the body. Bile is produced in the liver and stored in the gallbladder.

When fat is ingested in the body as food it signals the gallbladder to release bile through two tubes (cystic and common bile duct) into the upper part of the small intestine (duodenum).

Bile reflux may occur in combination with acid reflux, which may be due to a poor reaction of the body to acid-suppressant medications. It may be difficult to distinguish between bile reflux and acid reflux because of the similarity of the symptoms. While acid reflux can be managed with changes in diet, treatment for bile reflux includes medications or in severe cases, surgery.


Symptoms of bile reflux include:

  • Pain in the upper abdomen that can become severe
  • Frequent heartburn
  • Nausea
  • Vomiting a greenish-yellow liquid (bile)
  • Unintended weight loss
  • A cough or hoarseness on occasion


Bile reflux into the stomach

Bile and food are mixed in the duodenum and then enter the small intestine through the pyloric valve (a ring of muscle located at the outlet of the stomach). The pyloric valve opens slightly to release enough liquefied food at a time but not enough to cause digestive juices to reflux into the stomach.

Bile reflux is often caused by the pyloric valve not functioning correctly and bile refluxes back into the stomach.

Bile reflux into the esophagus

Bile and stomach acid sometimes reflux into the esophagus due to a malfunction of the lower esophageal sphincter valve. The sphincter valve separates the esophagus from the stomach and opens to pass enough food into the stomach. Bile can reflux into the esophagus if the esophageal sphincter valve is weak or relaxes abnormally.

Other causes of bile reflux include:

  • Surgery complications: Gastric surgery such as gastrectomy (removal of the stomach) and gastric bypass surgery can often cause bile reflux.
  • Peptic ulcers: Peptic ulcers can block the pyloric valve obstructing its opening so the stomach does not empty properly.  Stagnant food in the stomach increases the gastric pressure, which leads to bile and stomach acid to reflux into the esophagus.
  • Gallbladder surgery (cholecystectomy): Cholecystectomy significantly increases the bile reflux.


Bile reflux combined with acid reflux can cause complications such as:

  • GERD: Frequent heartburn is a common symptom of GERD. GERD can become a serious condition that causes irritation and inflammation of esophageal tissue due to excess acid.
  • Barrett’s esophagus: Barrett’s esophagus can occur due to long-term exposure of the lower esophagus to stomach acid and bile. Acid and bile damage the esophageal tissue increasing the risk of esophageal cancer.
  • Esophageal cancer: Some experts suggest that esophageal cancer can result from acid or bile reflux.