Memorial Kayseri Hospital, Department of Gastroenterology, Assoc. Dr. Mustafa Kaplan gave information about bile and acid reflux and made important warnings.
Reflux, which is seen in about 20% of people, becomes a bigger problem during Ramadan due to the prolonged hunger period. In order to control the reflux, which disrupts the comfort of life, during Ramadan, it is necessary to make changes in lifestyle and implement simple measures. When reflux is not treated, it can lead to esophageal damage and even cancer in the future. Memorial Kayseri Hospital, Department of Gastroenterology, Assoc. Dr. Mustafa Kaplan gave information about bile and acid reflux and made important warnings.
Two types of reflux
Bile reflux occurs when bile, a digestive fluid produced in the liver, escapes back into the stomach and in some cases into the esophagus, while acid reflux occurs due to the backflow of stomach acid into the esophagus. As acid reflux causes irritation and inflammation in the esophagus tissue, it can also lead to 'gastroesophageal reflux' disease. Unlike acid reflux, bile reflux, unfortunately, cannot be completely controlled by changes in diet or lifestyle. In severe cases, surgery is required.
Symptoms of bile reflux
Since the treatment approaches are different, it is necessary to differentiate bile reflux from acid reflux. These two problems, whose signs and symptoms are similar, can occur at the same time. Symptoms of bile reflux are:
- Upper abdominal pain that may be severe
- Frequent heartburn with a burning sensation to the chest and sometimes to the throat and a sour taste in the mouth
- Vomiting a greenish yellow liquid (bile)
- Sometimes cough or hoarseness
- Unwanted weight loss
Bile is important for digestion
Bile is needed to digest fats and remove worn-out red blood cells and some toxins from the body. Bile is produced in the liver and stored in the gallbladder. If a meal containing even a small amount of fat is eaten, a small tube in the gallbladder is signaled to secrete bile into the small intestine (i.e. duodenum).
The stomach lining can become inflamed
Bile and food mix in the duodenum. The 'pyloric valve', a muscle ring located at the stomach outlet, opens slightly enough to release about 3,5 milliliters or less of liquefied food at a time. This opening does not allow bile and other digestive juices to pass into the stomach. In the case of bile reflux, the valve does not close properly and bile escapes into the stomach. This can lead to inflammation of the stomach lining (i.e. bile reflux gastritis).
4 problems that occur as a result of bile reflux
- Studies have shown that reflux of bile can increase gastritis and lead to stomach cancer.
- If bile escapes into the esophagus, it causes complaints similar to gastroesophageal reflux disease. If patients do not benefit from strong acid-suppressing drugs, bile reflux should be suspected.
- Prolonged exposure to stomach acid or bile damages the tissue in the lower esophagus. Damaged esophagus cells have an increased risk of turning into cancer. In animal studies, bile reflux has been determined to cause Barrett's esophagus.
- There is a link between acid and bile reflux and esophageal cancer, and this may not be diagnosed until it is quite advanced. Studies have found that bile reflux alone causes esophageal cancer.
These may be the cause of bile reflux
Surgical complications: Gastric surgeries, including gastric bypass surgery, may be responsible for the development of bile reflux, or for weight loss.
Peptic ulcers: When stomach and intestinal ulcers hold the 'pyloric' valve, the valve may not close properly, causing reflux.
Gallbladder surgery: People who have had their gallbladder removed face significantly more bile reflux than those who do not have this surgery.
Can be diagnosed quickly with modern methods
The diagnosis of reflux can only be made by listening to the patient's complaints. However, to distinguish between acid reflux and bile reflux, some tests are required to see the level of damage-injury-ulcer and to check for precancerous changes.
Endoscopy: It is the process of investigating bile, peptic ulcer or inflammation in the stomach and esophagus by entering a thin, flexible tube (endoscope) with a camera through the throat. In addition, tissue samples, ie biopsies, can be taken to test Barrett's esophagus or esophagus cancer.
PH meter: In this test, a thin, flexible tube (catheter) with a probe at its end is sent through the nose into the esophagus. The probe measures the acid in the esophagus over a 24-hour period. Thus, acid or bile exposure of the esophagus is determined.
Esophageal impedance: This test measures whether gas or fluids flow back into the esophagus. It is useful for people who vomit non-acidic substances (such as bile) and cannot be detected with an acid probe.
7 suggestions to reduce reflux complaints
Lifestyle changes and medications can be very effective for acid reflux, bile reflux is difficult to treat. However, since many people experience both acid reflux and bile reflux, the complaints can be alleviated with lifestyle changes.
- Stop smoking: Smoking increases reflux by increasing gastric acid production, relaxing stomach lids and drying saliva that helps protect the esophagus. Smoking should be quitted for him.
- Choose smaller portions: Eating less and often helps prevent the valve from opening at the wrong time by reducing the pressure on the lower esophageal sphincter.
- Stand up straight after eating: Do not lie down immediately after eating. Especially after sahur, a period of time should be waited and the stomach should be given time to empty.
- Limit fatty foods: Eating high-fat meals for iftar and suhoor loosens the lower esophageal sphincter and slows the rate at which the food leaves your stomach.
- Avoid problematic foods and drinks: Some foods increase stomach acid production and can relax the lower esophageal sphincter. Foods to avoid during Ramadan include caffeinated and carbonated drinks, chocolate, citrus and fruit juices, vinegar-based sauces, onions, tomato-based foods, and spicy foods and mint.
- Lift your bed: Sleep with your upper body 10-15 centimeters above. Raising the head of your bed with blocks or sleeping on a foam wedge is more effective than using an extra pillow.
- Relax - avoid stress: When under stress, digestion slows down and reflux symptoms likely get worse. Relaxation techniques such as deep breathing, meditation, or yoga can help.