Biliary reflux

Biliary reflux, also called bile reflux, duodenogastroesophageal reflux (DGER) or duodenogastric reflux, is a condition that occurs when bile and/or other contents like bicarbonate and pancreatic enzymes flow upward (refluxes) from the duodenum into the stomach and esophagus.

Biliary reflux is often mistaken for acid reflux (gastroesophageal reflux disease, GERD). The difference is in the fluid involved:

• Acid reflux (GERD): stomach acid moves up into the esophagus.
• Bile reflux: bile and enzymes from the small intestine move into the stomach and esophagus.

These conditions are often related, and differentiating between the two can be difficult.

Bile is a digestive fluid made by the liver, stored in the gallbladder, and discharged into the duodenum after food is ingested to aid in the digestion of fat. Normally, the pyloric sphincter prevents bile from entering the stomach. When the pyloric sphincter is damaged or fails to work correctly, bile can enter the stomach and then be transported into the esophagus as in gastric reflux. The presence of small amounts of bile in the stomach is relatively common and usually asymptomatic, but excessive refluxed bile causes irritation and inflammation. Bile reflux has been associated with gastric cancer, chemical gastritis and the development of ulcers.