Bile is a greenish-yellow liquid made by the liver and stored in your gallbladder until you eat or drink. It helps you digest food and fluids by breaking down fats, including cholesterol, into fatty acids.
Your body then takes up these acids into your digestive tract. Yellow bile also helps carry bilirubin out of your body — the compound left over from the breakdown of red blood cells.
Bile breaks down fats so well because it’s mostly made of water, bile acids, and salts. This yellow bile can sometimes flow back up into your esophagus, the tube connecting your stomach and mouth.
If bile surges up into your esophagus often, it might be bile reflux. It’s also called alkaline reflux or biliary gastritis because bile has a bitter taste that can inflame your stomach lining. Find out about bile reflux, how it’s different from acid reflux, and which treatments can help.
What Is Bile Reflux?
Bile reflux can happen when yellow bile from your small intestine backs up into your stomach and esophagus. It can affect how your stomach works and cause damage to the lining of your stomach, esophagus, and mouth.
Symptoms often occur when bile flows back into your stomach from the duodenum (the first and shortest part of your small intestine). The duodenum contains bile that moves around freely. Because the ring of muscle called the pyloric valve doesn’t shut properly, bile can build up to flow back into your stomach instead of moving through your small intestine.
The reflux of bile can cause inflammation of your stomach lining, also called gastritis. Even though your body uses only a small amount of bile, your liver deposits large amounts into the intestines every day. Most of this bile is normally absorbed back into your bloodstream within the ileum, the longest part of your small intestine. But bile reflux isn’t the same as acid or gastric reflux.
Gastric reflux happens when the contents of your stomach move back into your esophagus. If you get acid reflux often, it can lead to gastroesophageal reflux (GERD).
Because acid and bile reflux can happen together, it can be hard to tell bile reflux from GERD. You may be able to control your acid reflux with lifestyle habits, diet, or medicine. But bile reflux treatment can involve medicine and, sometimes, surgery.
What Are the Symptoms of Bile Reflux?
Because both acid and bile can get pushed into your esophagus, you might have similar symptoms. With bile reflux, you may have:
- Heartburn, frequently
- Loss of appetite or nausea
- Upper belly pain, sometimes severe
- Vomiting of yellow or green bile (bilious vomiting)
- Weight loss without trying
It’s not as common, but you may also get a cough or hoarseness with bile reflux.
What do bile reflux symptoms feel like?
Symptoms can feel different for everyone. But with stomach problems, bile reflux may feel like bloating, cramping, indigestion, or excessive wind.
If you feel a burning sensation that radiates toward your throat or mouth, especially after meals, it might be heartburn. It can get worse after you lay down, bend over, or lift something heavy. Having hot, spicy, or acidic foods or drinks can also bring on heartburn.
The effortless return of gastric contents into your esophagus, often reaching your mouth, is called regurgitation. This symptom can bring acidic or bitter foods or fluids up during the day or at night.
It’s not as common, but chest pain is also a symptom of bile reflux that can sometimes lead to bilious vomiting.
Causes of Bile in Vomit
Sometimes when you vomit, you may notice a greenish-yellow material, which could be bile. It’s no cause for concern in most cases, especially if you vomit while your stomach is empty.
If you notice bile in your vomit more than once, you may have:
- Surgery complications from a gastric bypass or removal of part or all of your stomach
- Had your gallbladder removed
- Stomach ulcers that block the flow of bile and stomach acid
Other factors may also raise your risk for bile reflux, but the research is ongoing. These factors include:
- Taking certain medications
- Having a body mass index (BMI) of 30 or more
- Mental stress such as anxiety and depression
Diagnosis of Bile Reflux
Your doctor will likely run tests and take a look inside your throat and stomach to check for any damage. Bile isn’t acidic like stomach acid, so your doctor uses different tests to find yellow bile.
To diagnose bile reflux, your doctor may suggest:
- Endoscopy, which helps check for and measure bile reflux in your stomach and esophagus
- Esophageal impedance testing, in which bile isn’t normally present, but finding any is a sign of bile reflux
- Ambulatory acid test, which helps rule out acid reflux by measuring when and how long acid backs up into the esophagus
How Is Bile Reflux Treated?
Unlike acid reflux, bile reflux seems unrelated to lifestyle factors. Bile reflux is also harder to treat, but your doctor will go over your medical history and come up with the best treatment for your particular health. They may offer you:
- Ursodeoxycholic acid, a natural bile acid to help ease your stomach symptoms
- Proton pump inhibitors, which may help block and lower stomach acid levels
- Sucralfate, which forms a protective barrier in the lining of your stomach and esophagus
- Bile acid sequestrants, which may bind up bile salts (but other treatments might work better)
- Baclofen, which may help prevent the lower esophagus from relaxing to reduce the risk of reflux
Things you can do to help
Because many people have both conditions, lifestyle changes may help ease acid reflux symptoms. You can try to:
- Eat smaller but frequent meals.
- Make sure your head is raised up about 4-8 inches so the food does not move back into your mouth from your stomach when you lay down.
- Reach your target weight so food keeps moving through your gastrointestinal (GI) tract.
- Avoid stressful situations, and try to relax as much as possible. Remember the gut-brain axis — your mood can affect your digestion.
- Eat your evening meals two to three hours before going to bed.
- Avoid smoking or drinking alcohol, and try not to take in secondhand smoke whenever possible.
- Always ask your doctor before taking any new supplement or medication.
- Drink plenty of clean water for hydration.
Complications of bile reflux
If untreated, bile reflux can cause discomfort and complications because it also brings up stomach acid into your esophagus. Over time, the bile can get mixed with stomach acid and may cause:
GERD. It is usually caused from acid reflux. But if you’re still having symptoms after treatment, talk to your doctor about bile reflux.
Barrett esophagus. It is a serious long-term condition where stomach acid can damage the lower part of your esophagus and raise your risk for cancer.
Esophageal cancer. Reflux can damage tissues and cause cancer of the esophagus, which is often found at an advanced stage.
Surgery for bile reflux
If medicines aren’t working for your bile reflux, your doctor may talk about two different surgeries that treat bile reflux.
Diversion surgery. It makes a new connection for the bile to drain down into your small intestine, away from your stomach. That way, yellow bile doesn’t back up into your esophagus.
Anti-reflux surgery. In this, the part of your stomach that is closest to your esophagus is wrapped and sewn around the lower part of the esophageal sphincter. This may help the pyloric valve be stronger and lower your chances of acid reflux. But there’s not much evidence that it helps with bile reflux.
Takeaways
Bile reflux can happen after yellow bile from your small intestine backs up into your stomach and esophagus. You might notice it after stomach ulcers, a stomach surgery, or gallbladder problems. Even though acid reflux from your stomach into your esophagus can lead to similar symptoms, bile reflux often needs medicine or surgery. If you still have symptoms after treating your acid reflux, ask your doctor about bile reflux. Getting treatment early can help you avoid complications such as Barrett esophagus and esophageal cancer.
FAQs About Bile Reflux
What color bile is concerning?
Sometimes, your vomit can be yellow or green. This means you are throwing up bile. Get medical care right away if you:
- Have red, brown, or black vomit or vomit that looks like coffee grounds, which can mean blood
- Get symptoms of bowel obstruction, such as serious belly pain, being unable to poop, pass gas, or stop vomiting, or can’t keep food or drinks down
Keep in mind that you can sometimes throw up a little bit of yellow bile. But if you keep throwing up, see your doctor about bile reflux or a blockage (bowel obstruction).
What should I eat if I throw up yellow bile?
Vomiting bile can be hard on your throat and stomach. Try to:
- Suck on ice chips.
- Sip on cool water, clear fluids, or diluted juice.
- Eat small portions. Take small bites to start, and work up to small meals such as bland crackers, rice, and bread.
How long does bile vomit last?
It depends on why you’re throwing up bile. If you have a stomach virus, you might throw up for 24 hours until you get over the illness. If you can’t stop vomiting bile even after a few days, see your doctor. They can help figure out what’s causing you to throw up bile.
