Burning pain hard to stomach
When 35-year-old Stephen Lee (not his real name) walked into Dr Wayne Hu's office complaining of burning pains in his stomach, he was at his wit's end.
A year earlier, Lee had had his gall bladder removed; he began experiencing abdominal pain several months later. The pain was much worse after meals, so it was hard to tell whether it was a general stomach ache or something more serious.
With a history of gastric problems, Lee underwent a gastrointestinal endoscopy, which found a small erosion in his stomach. His doctor at the time diagnosed him with a superficial ulcer, prescribed him medicine and sent him on his way. But the pain returned soon after the course of medicine ended, so Lee made an appointment with Hu, a specialist in gastroenterology and hepatology.
Familiar with symptoms such as these, the doctor performed a repeat endoscopy, this time testing for bile reflux. His suspicions proved correct, as the procedure found bile had risen from the small intestine to the stomach.
Bile reflux is more common than one might think, and many sufferers are unaware they even have it.
Anyone can be affected by it, but those who have had gastric surgery, such as the removal of their gall bladder or stomach, are 30 per cent more susceptible to the condition, Hu says.
'Bile is produced in the liver to aid in the process of digesting fat and is stored in the gall bladder,' he says. 'It is released via the second part of the duodenum, which is connected to the small intestine by the pyloric valve. Its release normally occurs when you eat, through the contraction of the gall bladder, so when the pyloric valve is damaged, it alters this timed synchronisation. What happens is the bile is then released at random and also flows upwards to the stomach, causing inflammation of the stomach lining and extreme gastric pain.'
Symptoms and complications
Long-term misdiagnoses of bile reflux can lead to serious consequences. Gastritis (the most common form of stomach irritation), if left untreated, can lead to bleeding and stomach ulcers. In some instances, bile can travel as far as the oesophagus (food pipe) and combine with acid.
If left untreated, the combination can inflame the lower oesophageal lining and cause Barrett's oesophagus, whereby the cells in the food pipe start to build new cell structures to protect it from the acid and bile. Eventually, this can lead to oesophageal cancer.
Hu says that misdiagnoses are often due to the symptoms of the condition - a burning pain in the stomach area and nausea, which are also traits of gastroenteritis.
'In some cases, people may also experience heartburn and mistake it for acid reflux. More often than not, sufferers will simply ignore the pain, excusing it as one of the aforementioned, or doctors will simply prescribe medicine to manage the stomach pain.
'Secondly, a gastric endoscopy does not necessarily find signs of bile. As in the case of Lee, the small erosion and inflammation in his stomach was misdiagnosed as an ulcer. If there is bile, this can also be attributed to retching. The only sure-fire way of diagnosing bile reflux is to measure bile exposure.'
Although there is no outright cure for the condition, medicine can alleviate it. Ursodeoxycholic acid, for example, promotes the flow of bile and reduces pain symptoms, while medicines such as proton pump inhibitors can stop acid production in the stomach.
Leading a healthier lifestyle with a reduced intake of alcohol, fatty foods, carbonated and acidic drinks and weight loss can also help ease acid reflux.
If the condition cannot be managed, then surgery may be required. An operation called a Roux-en-Y bypass creates a new connection in the small intestine that the bile drains into, thereby directing it away from the stomach.
Those who have been experiencing persistent stomach problems for a few months should seek urgent medical advice, Hu says. Those who are also experiencing reflux-like symptoms and are not responding to prescribed medicine should seek a second opinion or insist upon further tests.
Lee is now taking a three-to six-month course of medicine to help manage the pain and reduce bile reflux symptoms.