A 29 –year- old man presented with recurrent attacks of epigastric pain. The patient received treatment in the form of proton pump inhibitors and prokinetic medications without improvement. Upper GI endoscopy revealed bile reflux into the stomach up to the lower esophagus with severe gastritis. Multiple biopsies were taken and showed gastric metaplasia.
Definitions:
Bile reflux#: a condition that occurs when bile flows upward from the duodenum into the stomach and esophagus.
Bile: a digestive fluid produced by the hepatocytes, stored in the gallbladder, and discharged into duodenum after ingestion of food.
The presence of low amounts of bile in the stomach is relatively common and usually asymptomatic, but excessive refluxed bile causes inflammation.
The pyloric valve opens only slightly to release about 3.5 ml of food at a time, but not enough to allow digestive juices to reflux into the stomach. In many cases of bile reflux, the valve does not close properly, and bile washes back into the stomach.
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