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BILE REFLUX

ARE MY SYMPTOMS CONSISTENT WITH BILE ACID REFLUX?

Most of my GI tests (ultra sonogram, colonoscopy) have been unremarkable with exception of the upper GI endoscopy that indicates:

Stomach, antrum (biopsy): gastric anthral mucosa with chronic active gastritis and intestinal metaplasia; negative for displasia

Stomach, body (biopsy): Gastric body (oxyntic) mucosa with active gadstritis. Bacteria consistent with Helicobacter pylori are present.

Gastroesophageal junction (biopsy): Fragments of cardiac-type mucosa with intestinal metaplasia; no dysplasia identified. Active esophagitis.

Otherwise, my symptoms are:

1-Mild Bitter taste in my mouth when I wake up despite having eaten a light meal (in terms of fat and refined carbohydrates) for at least 3 hours before going to bed. That taste is absent whenever I sleep in a semi-seated position.

2-The taste is associated to a hoarse throat, a light yellowish tongue coat, and occasional cough. Taste disappears quickly while preparing breakfast.

3-Ocassional belching and flatulence during digestion of bean dishes

4-Abdominal discomfort or stomach activity in the upper left and/or right lower abdomen after eating highly processed foods (bread or sweets) or fatty heavy dinner.

5-Ocassional fullness, nausea, vomit after eating sweet fatty pastry while walking in cold weather.

Family History:

1-gallbladder stones
2-bile vomit/pancreatic cancer

8 Responses
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875426 tn?1325528416
Looks like walking tests for acid are negative for people with bile reflux & impedance testing may be encompassed by the esophageal manometry-motility test.
Helpful - 0
875426 tn?1325528416
Drugs are a two-edged sword a lot of times!  When does the doctor intend to check your husband?  I had no idea H. pylori was a bacteria that would spread like that!  I think your doctor should be getting a move on- it's your physical well being at stake here- very serious business & not just a trifle... I wonder why he didn't seem in a hurry?  What do you mean by impedance?
Helpful - 0
Avatar universal
Hi livinginhope

I missed your email from yesterday.

About bile reflux, I found three GIs who  do the impedance/pH monitoring test in the esophagus. It was a very convoluted way to get them (out of network GI, insurance, in network GI, referral to in network GI who perform esophagus function test).
I will recommend you to do the pH w the impedance back to back to figure out your case.


You are absolutely right the bilis is regulated by a valve (pyloric valve) that prevent reflux onto stomach. I will read the mom's post to learn some more.

As far as my HP treatment, I am for the antibiotic treatment using the probiotic w delayed response not to ruin the HP
Eradication in the stomach. My GI
Ask me to wait until he checks my husband for HP to avoid back and forth Infection. He is always book a month in advance. So I have to wait until i see him next week to further discuss my diagnosis. In the meantime I am trying to learn about potential complication with the PPI. If my stomach pH Is Already higher than 1-2, the PPI will really hurt my digestion and even prevent the HP eradication
and who knows what else.
Also the GI did not seem in a hurry to start the treatment immediately.

Yes I will look into the MRI or MRCP.

Well about the food. Besides the bitter taste and intestinal  gas, I am wo pain most of the time. So it is a balance, I want my body to fight back. I don't want to depend on drugs. Usually there are unknown long term side effects. I have learnt that by example.

Bye
Helpful - 0
875426 tn?1325528416
As you may know the liver produces the bile and the gallbladder stores it for when it is needed to break down fat (if memory serves me correctly).  You may want to look at this disturbing outcome for one medhelp poster's mom:
http://www.medhelp.org/posts/GERD-Acid-Reflux/Issues-after-Gall-Bladder-Removal/show/1533249?personal_page_id=862335

That Mayo article you mentioned I briefly looked at was the only other time I'd heard about a gall bladder reflux type thing.  But since the liver produces it, unless the reservoir gall bladder organ can be repaired, if it has a faulty sphincter valve or whatever, it would seem (conjecture here on my part) like gall bladder removal wouldn't solve the problem of bile flowing where it's not supposed to go.

The Bravo is supposed to follow the ph for two days.  But I do have a concern about my gall bladder in that the HIDA scan tracer dye didn't empty out of my gall bladder until about 70 minutes went by, longer than the normal amount of time it takes to show up in the small bowel.  I also got an MRCP, which you might look into- it uses magnetic resonance imaging to look at the bile duct work and pancreatic duct work- which in me looked fine to the reading radiologist on it.

It looks like from the national institute of health article that they are calling h. pylori "infection" and are saying it is responsible for gastric inflammaton, so I think you would want to get further testing along the lines I'm scheduled to have, to learn about how much acid (if any) is refluxing into your esophagus.  It also looks like the NIH article is from 2008.  And they say there are some issues unsolved with the treatment so it's not (as of the time of the article) yet an accepted standard treatment.  Also, garlic, on their list, is one of those things people list as forbidden to those with acid reflux, and you wouldn't want green tea with caffeine in it, as caffeine is also forbidden- if you have acid reflux.  But evidently, there is de-caffeinated green tea.  Broccoli and brussel sprouts can cause gas, so if you are experiencing that already, your bowels may not welcome them.

Might I recommend you tell your doctor ASAP the issues you have with the acid reducing portion of your treatment- it looks like h. pyloric can cause inflammation, but you are not convinced you have acid reflux?  I think you're putting yourself at risk if you delay the antibiotics part that fights the h. pylori infection (along with taking your pro-biotics at the same time)- have you started that part yet?  
Helpful - 0
Avatar universal
Hi again,


Yes I have to follow up with my GI about having more tests done.
Yes, I got your reference about IM..Thanks

The question about loosing weight in case of having bile reflux:
I don't have that either, but I could hypothesize that it is a question of degrees.
One may have a mix of bile and acid in the stomach that still allows you to digest enough food to keep your weight. The bile is alkaline and neutralizes the stomach acid. The final PH will depend on how much acid you secrete and how much bile has leaked into the stomach.
So having the pH measurement at different times will be necessary but insufficient (you may have a pH> 1 or 2 at digestion times because your stomach secretes abnormally low levels of acid). So I think that it is important to have another test to follow the bile. I found a test for bile cruising through the web, but I need to research more.

I have reviewed a few medical abstracts during my search and the presence or absence of HP in the human stomach is not well understood. There are some scientists (not MDs) who believe that HP is present in small  numbers in everybody's stomach. So I wish that incorporating new foods I could place it under control (See the following links: http://en.wikipedia.org/wiki/Helicobacter_pylori and http://www.ncbi.nlm.nih.gov/pubmed/18956590)

Recent studies from 2008 indicate food sources used in Japan and Korea to have HP under control with natural sources (Brussel sprouts, Kimchee) and somebody in Mass that points to green tea.

I am however aware that HP infection and IM place me at risk of having ulcers and stomach cancer.  My strong concern is the following:
The HP treatment  assumes that I have acid reflux and that inhibiting the acid will allow my esophagus to heal and that may be wrong and thus it may throw me out of balance and even place me in a position to get re-infected in a few months.

Hope to hear from you again.
Helpful - 0
875426 tn?1325528416
I had another thought- low right side, besides bowels down there, do you still have your ovary on that right side?  It hangs down pretty low-if you still have it, you might want to check with a gyn to rule that out.  

I sent you a link on IM- did medhelp send you another one?  

Regarding simethicone- you can get it over the counter- one name is gas-x.  It is supposed to help you expel gas.  I had a problem clear back when I was a teen with sharp gas pains and in my case at that time, the doctor said it was a sharp turn, I think where the small intestine ended and the large bowel began and pockets of gas were getting caught.  They had me start taking simethicone regularly after meals, if I remember right.  

Re: knee chest- there are two positions you can get in to try to allow gas to pass out of you- with one you bring both knees to your chest and another is where you lie on your side, with the bottom leg straight out while you bring the other knee toward your chest.  Exercise- whether it be walking, jumping jacks (if you are fit), or any activity that might help get our bowels moving to where they expel the painful gas pockets.

Regarding your theory about acidity- I am scheduled later this month to get a couple of tests that look at the ph level & see just how much acid is refluxing up into my esophagus and at the muscle activitiy of the esophagus.  One is a Bravo inserted during EGD and comes with a little recorder box, I believe.  The other is where they put the tube down the nose and slowly draw it up, having me take sips and swallow at certain times.  You might want to ask your GI doctor whether either or both of those tests (the esophageal manometry-motility and the Bravo) would be right for you.  

In any event, whatever the treatment they gave you specifically for getting rid of the H. pylori is important, as that is not a normal finding and can lead to ulcer formation, and in your case, with the changed cells is part of the threat of the cancer potential.

I'm glad you are taking the pro-biotics...as you probably know antibiotics kills not only the bad H. pylori bacteria, but the good bacteria in your intestinal tract as well.  I had someone some time back recommend me taking acidophilus capsules when I take antibiotic and it worked for eliminating the side effect of diarrhea- yay!  I had gastritis and esophagitis with my last EGD, but was negative for H. pylori.  

The GI doctor I am now seeing told me how below your diaphragm, where you stomach lies, it is a high pressure area, where as above your diaphragm, where your lungs are, it is low pressure (can't remember if he said negative pressure).  Anyway, when the sphincter muscle that is supposed to stay closed between your stomach and your esophagus has weakened and is no longer staying closed, like it is supposed to, the acid from your stomach (high pressure area) naturally wants to go up to the low pressure area, where your esophagus is located.  And while your stomach has a certain kind of lining God designed to protect against the strong stomach acid, but the esophagus lining is like your skin.  He compared the acid hitting your esophagus to pouring hydrochloric acid on the skin of your arm.  

So, I think you need to know if that sphincter muscle is not working the way it should and you need to have your ph level measured if you have not had that done yet before you definitely decide what treatment you are going to embark upon with it comes to proton pump inhibitors or not.  I think they may be trying to help your esophagus to heal from the inflammation the acid refluxing up there is causing by trying to limit the amount of acid in your stomach.

  I can't explain though why I had gastritis though, when the stomach has the lining that is supposed to withstand its acid.  I'm not sure, in your case, if the H. pylori is causing your chronic gastritis and even the esophagitis- the doctor should know though, so that might be a question you could ask if you don't know either.  But looking into bile reflux, from that article you mentioned, sounds like something to pursue,since it looks like THAT can cause gastritis- something you and I both suffer from.  But it does look like that typically comes along with losing weight without trying, which isn't happening on my end - how about you?  Also, let me send you a PM about LPRD- you've got to see this and stack it up with what you're describing and see if it doesn't line up at all?

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Avatar universal

Thank you very much for all your suggestions and information. Points well taken.

I will request a HIDA scan to explore further potential problems with gallbladder

I will ask my GI whether I have gastroesophageal reflux disease (GERD) and/or laryngopharyngeal reflux disease (LPRD)

My appendix was removed 10 years ago.

Please tell me more about "Simethicone" and exercise..knee chest.

I have the prescription (2 antibiotics and PPI) to erradicate H.P.,  but I have not started that yet.

Thank you for pointing up to the anti-oxidants. I have changing further  my lifestyle:  
Probiotics with delayed response, antiooxidants, eating smaller meals, sleeping with torso up etc. My diet has been  essentially very non-processed foods, large variety of organic produce meats for the last 4 years, but I had a horrible couple of years with dental problems (inflammation and infections), nasal rhinitis and that may have thrown my digestive system out of balance. So yogurt and non-processed organic food prepared from scratch may not have been enough in my case.

I also forgot to mention that I am a 60 years old with very strong background in Chemistry/Biochemistry, a 15-year breast cancer survivor, and a strong believer of preventive medicine. In  short, I am nowadays very reluctant to take any drugs without researching them well.

I read the article sent to me by this site about IM and its association to acid and/or bile reflux. I also  researched the mayo clinic site among others. All the info  leads me to believe that I may have low acidity instead of high acidity in my stomach and that my esophagitis may be due to bile/acid reflux instead of acid relux alone.

In short, I have second thoughts about taking the PPI  that accompanies the two antibiotics to erradicate the H.P. for the following reasons:

1-Esophagitis is consistent with acid or acid/bile reflux

2-The bitter taste after waking up, hoarse throat and cough are also  consistent with bile reflux (search for bile reflux symptoms in Mayo clinic).

3-Unclear whether PPIs are recommended for patients infected with HP who  have already abnormal low acidity instead of high acidity.

Please don't hesitate to send more info that may clarify my situation and clarify whether the PPI are essential in my case to erradicate HP.

Thanks




Helpful - 0
875426 tn?1325528416
Let me preface with I'm not a doctor, but a patient.

I had a surgeon advise that sometimes a HIDA scan (you will want one with ejection fraction) can reveal what an abdominal ultrasound misses when it comes to the gallbladder.  So you might want to ask about that.

You also evidently had the bacteria H. pylori present, which can lead to the formation of ulcers- did they give you antibiotic for this?  Metaplasia means your body is replacing normal cells with abnormal ones.  It means you are at risk for developing gastric cancer and must take steps to try to reverse if if possible with anti-oxidants and getting rid of the H. pylori.  You tested negative for dysplasia, which means they didn't identify any pre-cancerous lesions.  See private message for more information.

You also list a number of symptoms consistent with acid reflux- the bitter taste in your mouth, the hoarse throat and the cough.  Having symptoms act up after eating certain foods can also happen when the foods are the varieties that stimulate more acid secretions in your stomach.

The fact that you have not only gastritis, but esophagitis (like I did on my last EGD), says to me that very likely the acid from your stomach is refluxing up into your esophagus, which can happen in GERD- gastroesophageal reflux disease.  The fact you mention hoarse throat and cough makes me think you should ask the doctor if you have laryngopharyngeal reflux disease (LPRD).

Where you are having the pain- upper left- if it is toward the front of your abdomen, below your diaphragm, this is likely your stomach doing the hurting, and no wonder, since you are suffering from chronic gastritis.  The pain on the lower right- make sure with a doctor you don't have appendicitis, but other than that, since your colonoscopy was negative, there's a strong possibility you are getting gas pockets building up in there.  Have you tried simethicone and exercise when this happens or the knee chest?
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