What Are the Causes of Pediatric Bile Reflux?

Bile reflux, or duodenogastroesophageal reflux (DGER or DGOR), is a condition similar to acid reflux where bile backs up into the stomach. It occurs when the pyloric valve that connects the small intestine and stomach does not close properly.

Causes

• The most common cause of bile reflux is complications from surgery, including gastric surgery and cholecystectomy. Gastric surgery is increasingly used to treat childhood obesity. A cholecystectomy, or gallbladder surgery, removes the gallbladder when a child has recurring gallstones or other gallbladder disease. In some cases, a peptic ulcer can prevent the pyloric valve from opening properly. This creates a situation where the stomach can't empty as quickly as it should, leading to increased gastric pressure and causing bile reflux. A peptic ulcer is caused primarily by a bacterial infection that even kids can get.

Symptoms

• The primary symptom is a burning pain in the upper abdomen. Other symptoms in children, similar to those of acid reflux, include recurrent pneumonia, wheezing, coughing or hoarseness, vomiting, and weight loss.

Diagnosis

• Diagnosis of pediatric bile reflux includes review of symptoms and tests such as barium swallow, endoscopy, and esophageal pH monitoring. Because these procedures are invasive, the starting point for diagnosing children is to try bile reflux treatments and see if they relieve symptoms.

Treatment

• Treatment includes medication to promote bile flow and improve symptoms. Because bile reflux often occurs with acid reflux, treatment also typically includes acid reflux medications. For severe cases, diversion surgery or anti-reflux surgery may be recommended.

Related Conditions

• Bile reflux can cause other conditions including heartburn, gastroesophageal reflux disease (GERD), Barrett's esophagus, and esophageal cancer. Many of these conditions are rare in children, but without maintenance treatment, pediatric bile reflux can eventually result in these conditions.