Bile is a yellowish or green fluid produced by the liver and is stored in the gallbladder. Bile helps in the digestion of lipids breaking down fat molecules into fatty acids. Bile is made of cholesterol, bile salts, bilirubin, body salts and some metals. Bile reflux is a condition in which the bile fluid produced by the liver backs up to enter the stomach and further enters the esophagus and mouth. Acid reflux is the term used for pushing of stomach acids into the mouth which causes heartburn. Bile reflux is not the same as acid reflux which can be managed by diet modifications.
Vomiting bile is producing green or yellow color vomitus which involves presence of bile. Unlike acid reflux, bile reflux or bile vomiting cannot be ignored since it needs medical treatment. Vomiting bile is accompanied with nausea in infants and the parents have to be careful in dealing such cases. In adults also bile liquid is present in the vomiting in little quantities. Continuous vomiting after a meal can lead to dehydration and after sometime only water and mucus are ejected in the vomitus. Bile secretion will be at maximum shortly after eating a meal. In such cases if vomiting occurs repeatedly it may contain partly digested food particles along with mucus, bile and other enzymes.
Vomiting Bile Symptoms :
The signs of bile vomiting are more or less the same like acid reflex. Very often two things happen at the same time. Yellow green vomiting or bile vomiting can cause upper abdominal pain, nausea, and heartburn. The bile and other fluids from the stomach are sent back into the esophagus and food canal causing sour taste in the mouth. The vomitus would contain greenish yellow color fluid. For some people it can cause loss of weight if the vomiting is persistent.
Causes Of Vomiting Bile :
Bile is secreted in the liver and the release of bile fluids is almost the same timing as you consume a large meal. Bile mixes with food and enters the intestine through the small opening of the pyloric valve. Sometimes the pyloric valve would not close fully pushing the bile back in the stomach. Now the bile from the stomach reaches the esophagus due to the partial closure of esophageal sphincter muscular valve. This valve opens only to allow food particles inside the stomach but when it does not function properly, bile gets back into the esophagus causing heartburn.
Greenish yellow bile vomiting can occur due to the following factors.
- Obstruction In The Intestine – When there is any obstruction in the small intestine it would expel the contents of back into the stomach and into the esophagus and mouth that reciprocates as vomitus. Chronic constipation can cause such obstruction. Small bowels are blocked in the intestine in adults due to the presence of tumor, post-operative adhesions, irritable bowel syndrome or inflammatory bowel disease and presence of gallstone in the ileus. In the infants bowel obstruction can be caused due to malrotation, pyloric stenosis and presence of foreign bodies.
- Surgery – The person who has recently undergone gallbladder removal surgery can get bile vomiting. Bile is likely to enter the stomach causing gastritis and irritation of lining of the stomach forcing the bile into the esophagus.
- Peptic Ulcer – Any ulcerous growth in the stomach can push the bile fluid into the stomach and esophagus.
- Alcohol Abuse – People who drink heavily can get this problem due to the constant irritation of the stomach. Drinking alcohol in excess would affect the gastrointestinal tract causing irritation triggering bile vomiting. Similarly people who are using drugs like morphine or cocaine can get bile vomiting.
- Bile Reflux – People who have undergone gallstone removal surgery or gastric bypass surgery recently can develop bile vomiting due to excess of secretion of bile. They may also develop additional signs like heartburn, discomfort and nausea.
- Gastroenteritis – This is a viral infection and is caused by taking contaminated food or drinks. Constant vomiting occurs after eating until the food particles and water are completely expelled out.
- Food Poisoning – Eating undercooked meat and foods cooked in unsanitary conditions can cause infection and bile vomiting.
- Allergic Foods – Eating allergic foods can trigger immediate vomiting bile along with mixed food.
- Empty Stomach – Leaving the stomach for extended hours can cause bile vomiting.
- Cyclic Vomiting – In severe cases the person would vomit continuously for weeks together in spite of taking medications. Solid food cannot be tolerated in the stomach forcing to expel food with bile. It is difficult to treat cyclic vomiting and in many cases the patient has to be hospitalized to prevent dehydration and loss of fluids.
Diagnosis :
Your doctor may listen to the symptoms to identify the reflux problem. She may request for testing procedures like endoscopy to check whether ulcers are present in the stomach. Ambulatory acid test is done to confirm acid reflux problem. Alternatively esophageal impedance test can also be done.
Vomiting Bile Treatment :
The doctor would look into the actual cause of yellow green vomiting before starting the treatment. In case of intestinal blockage, surgery is the only option. For some people intestinal block is present during birth. The surgeon would cut open part of the intestine and remove it to clear the deformity and blockage. Treatment for GERD and bile reflux includes prescribing antacids of strong dosage. In severe cases fundoplication ((which involves wrapping the fundus and joining it together with lower esophagus sphincter valve) surgery is to be done.
For gastroenteritis the patient should be careful enough to prevent dehydration. Antiviral medications are given along with drugs like prometazien to control vomiting. One should be careful not to take allergic foods and contaminated or undercooked food. For people who have consistent bile vomiting ursodeoxycholic acid is prescribed which can drastically reduce the symptoms. Diversion surgery will be done for patients who have undergone gastric surgery and developed bile vomiting after surgery. The surgeon will create a new connection for drainage of bile fluids deep down the small intestine so that bile does not get pushed into the stomach.
Home Remedies :
- You can control vomiting by making small changes in food habits and lifestyle.
- Keep your body well hydrated by drinking plenty of water.
- You can sip few drops of cranberry juice whenever you feel like vomiting. Iced lemon juice can also be taken at regular intervals.
- Quit smoking and reduce the quantity of drinks.
- Instead of taking large meals three times a day, you can eat small frequent meals slowly.
- Identify the food allergies and other triggering factors and avoid them completely.
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