Bile in the stomach

[chris-w]

  I'm a 34 year old female who for two years has had chronic periumbilical pain, sacroiliac joint pain, diarrhea and/or frequent bowel movements, and abdominal distension.  I've had a colonoscopy, small bowel series and an upper GI endoscopy. Colonoscopy showed very, very mild inflammation in ascending colon. Small bowel series showed transit time of less than 15 minutes; otherwise no abnormalities. Upper GI endo showed rather large amounts of bile in my stomach (despite fasting for 14 hours) and very, very mild inflammation of lower esophagus. Slight, hiatus hernia, and a stomach that does not contract.  No ulcers.  I'm currently taking Zantac, Citrucel, and Carafate. They are providing no relief of pain and symptoms.  My doctor is perplexed.  Any suggestions for paths to pursue?  My research suggests that bile is not ever supposed to be in the stomach. What would cause it to be there and how to get rid of it?  By the way, I have had no prior surgeries or intestinal problems. I apologize for the length; just wanted to make sure I gave you enough info. Thanks, in advance, for your advice. It's awfully kind of you folks to provide this service.
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Dear chris w,
Your physicians have done a good job in excluding many of the causes for your symptoms.  Bile refluxing into the stomach is not as rare as your reading would suggest.  It is unusual, however, for the bile to cause any problems.  I would suggest a gastric emptying study to complete your workup.  If this test is normal, I would focus therapy towards regulating your bowel function and dealing with the gas.  Specifically, I would increase the amount of fiber that you ingest until you had 1-2 stool per day. To improve the gas, I would try over-the-counter remedies such as Phazyme or charcoal.  Propulsid, a prokinetic agent, has been reported to be helpfil in some people with your symptoms.
This response is offered for your general information and should not replace the conclusions drawn from a careful and complete evaluation by your physician.
If you want, we would be happy to see you in the Division of Gastroenterology at Henry Ford Hospital, in order to review your records and investigate your symptoms. Dr. Fogel of the Division of Gastroenterology would be able to see you and to quickly evaluate your symptoms.  He can be reached by calling the Henry Ford Physician Referral Line at [phone].
HFHSM.D.-rf
*keywords: irritable bowel syndrome, abdominal pain, diarrhea
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