Diagnosis and Treatment

The main diagnostic tests include an endoscopic examination of the oesophagus and stomach to check for inflammation or ulceration; a test to check for acid in the oesophagus (this would be negative if bile reflux is the only problem), and a test to determine if gas or liquids reflux into the oesophagus.

A medication called ursodeoxycholic acid can be prescribed to promote the flow of bile and reduce the symptoms and pain of bile reflux. Other drugs might be used to speed the rate at which food leaves the stomach.

Surgery is a treatment of last resort, used if nothing else reduces severe symptoms of bile reflux or when the oesophagus develops precancerous changes. The most common operation, called Roux-en-Y surgery, involves creation of a new connection to the small intestine to keep bile away from the stomach.

If acid reflux is also a problem, treatment with a proton-pump inhibitor should help, as should non-medical remedies including weight loss; limiting high-fat foods and alcohol; avoiding carbonated and acidic beverages, spicy foods, onions, vinegar, chocolate and mint; eating small meals; practicing stress-reducing techniques like meditation or exercise; not eating within two to three hours of bedtime; and sleeping with the upper body and head elevated.

WHAT, WHY AND HOW

• The lower oesophageal sphincter, a muscular ring between oesophagus and stomach, keeps stomach acids from backing up. Malfunctioning results in acid reflux

• Malfunctioning of Pyloric valve — the muscular ring between the stomach and small intestine — leads to bile reflux. Untreated, this can result in a bleeding ulcer or even stomach cancer

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