What neutralizes bile. Reasons for the release of bile into the stomach and ways to remove it

The consequence of cholecystitis, hepatitis or other inflammations in the liver, bladder, ducts is bile in the stomach. The intensity and nature of the pathology, as well as treatment, depend on the provocateur of the condition. Provoking factors are weak patency of the gallbladder ducts, incompetence of the duodenal sphincter (duodenum), in which the symptom appears frequently. If a lot of bile is released into the stomach no more than once a month, there is no need to worry. But if your stomach hurts regularly, or you experience bitterness on an empty stomach, you should seek medical help.

What does it mean?

An important element digestive system is bile. It is produced by the liver and stored by the gallbladder. When the need for bile arises for further breakdown of food, it must enter the duodenum. Under normal conditions, the bolus of food enters from the esophagus into the stomach, then into the intestines in one direction. The process is regulated by sphincters, which prevent the backflow of bile into the stomach. With coordinated work, bile should enter only the duodenum of the intestine with the appearance of a food bolus in it. There are a number of disorders and diseases that relax the sphincter, and it does not perform its function. In these cases, cloudy and foamy bile often ends up in the stomach.

Causes of bile release in the stomach

Bile may enter the stomach if:

increased pressure in the duodenum;
the sphincter connecting the stomach and duodenum has weakened;
The bubble has been removed.

Bile can be found in the lumen of the stomach during pregnancy.

Bile will be found in the lumen of the stomach under the following conditions and diseases:

Injury to the abdomen with disruption of the gastrointestinal tract muscles.
Pathological conditions in the form of oncology, chronic duodenitis, hernia, when high blood pressure in the duodenum weakens the sphincter.
Postoperative conditions with muscle damage.
Recovery after bladder removal.
Pregnancy. The gastrointestinal tract is compressed, which causes a surge in pressure. At the same time, a muscle-relaxing hormone, progesterone, is produced, which causes the sphincter to relax and bile to be released.
Effect of medications. As a result of the influence of some antispasmodics, a strong release of bile into the stomach is possible.
Sleep on full stomach, especially on the left side.
Insufficient production of protective mucus.

Typical symptoms of the disease

You can identify the reflux of bile into the stomach by symptoms:

Belching. As a result of interaction with digestive juice, the amount of gases increases, air with a pungent odor and bitterness in the mouth is released.
Bitterness in the mouth. It is often associated with a lack of food in the stomach, so the symptom is most severe on an empty stomach.
Bile impurities in vomit. As reflux becomes more frequent and their abundance increases, the stomach becomes very irritated and begins to contract. Vomiting allows you to get rid of the contents.
Yellow, dense coating on the root of the tongue.
Heartburn. Appears against the background of stomach irritation in the absence of protective mucus.
Pain in the epigastrium, but more often without clear localization. The pain often varies in intensity.

When collecting the stomach contents, foamy, cloudy, dark bile is revealed. Subsequently, symptoms of gastritis or ulcers appear, which is associated with aggravation due to untreated stagnation of bile.

Diagnostic methods

If bile is backfilled for several days in a row, you need to go to a gastroenterologist. The doctor will prescribe a diagnosis, which will reveal the cause and determine a treatment regimen. More often used:

Ultrasound. Tumors and cysts are detected in the liver, bladder, biliary tract, and pancreas.
FGDS. Using a mini-camera, the gastrointestinal tract is examined up to the duodenum, any defects in the mucous membrane and sphincters are identified. At the same time, a biopsy of suspicious tissue is taken and gastric juice is collected. Bile in pathology is cloudy and foamy.
X-ray with barium contrast. The condition of the gastrointestinal tract and sphincters is assessed, their location and functionality if pathology is detected.

It is important to understand that stagnation in the stomach due to frequent reflux of bile is not an independent disease, it is a symptom caused by certain disorders in the gastrointestinal tract. Diagnosis is important to identify the root cause. If bile is not removed from the stomach in a timely manner, more severe problems will develop against the background of constant irritation of the organ. chronic pathologies, such as gastritis and ulcers.

Treatment of the disease

After determining why the secretion accumulates and where it comes from in the lumen of the stomach, individual therapeutic regimens are developed. The goals of therapy are to stop the process, eliminate the effects of irritation of the mucous membrane, remove excess acid, and therefore prevent the development of complications. You can cure the disease:

mitigation of symptoms: diet with lifestyle correction, taking medications;
eliminating the root causes of bile stagnation in the stomach: antibiotics for Helicobacter, anti-inflammatory, choleretic, hernia surgery.

Surgery

Except chronic inflammation duodenitis (duodenitis), others pathological conditions in the gastrointestinal tract, accompanied by regular reflux of bile into the stomach, require surgical treatment. Operations are performed using two techniques:

Laparoscopy is a minimally invasive operation. Allows you to remove a tumor or correct another problem through several small incisions in the skin of the abdomen, where a camera with optics and tools for work are inserted. Advantages - smaller area of injury, short rehabilitation period, low likelihood of postoperative complications.
Laparotomy - classical technique, which assumes big hole in the peritoneum. This makes it possible to remove the diseased area of the gastrointestinal tract. There is a higher risk of complications and increased rehabilitation time due to the scale of the operation.

Drugs

The drug regulates the level of acid in the stomach by influencing the secreting glands.

Treated with medication physiological disorders, when the accumulation of bile is short-term and unstable. Chronic duodenitis should also be treated with medications. Exists specific list drugs that are used to reduce the symptoms of reflux. This includes:

Proton inhibitors - Omeprazole, Nexium. Medicines regulate the level of acid in the stomach by influencing the secreting glands, thereby neutralizing the environment.
Prokinetics - "Motillium". Their action is aimed at regulating motor function Gastrointestinal tract. When amplified contractility bile circulates faster.
Anatacids - “Maalox” or “Almagel”. Necessary to neutralize acidity.
Ursodeoxycholic acid - "Ursofalk". The medicine is necessary to convert bile into a water-soluble form, relieve symptoms such as belching, heartburn, nausea, and bitterness in the mouth.
Antispasmodics - to relieve pain.
Drugs that enhance bladder motility and eliminate congestion - magnesium sulfate, “Cholecystokinin”.

Heartburn in the stomach can be physiologically justified or pathological. It occurs extremely rarely in a healthy person and does not cause damage to the body. Pathology is considered when bile is thrown into the stomach and esophagus on permanent basis. Normally, this process is prevented by the protective sphincter of the duodenum. Under the influence of disease, the sphincter ceases to perform its functions. A lumen forms in it through which bile passes. In such a situation, doctors recommend starting treatment with medications. If this does not help, then you have to resort to surgery.

Causes of bile entering the stomach

The liver produces bile, which then passes into the gallbladder and duodenum. This fluid is needed by the body for digestion. Reflux is the reflux of bile into the stomach and esophagus. The process is accompanied by a burning sensation in the area solar plexus and throat. Bile has increased acidity. Therefore, there is a risk of getting a burn to the mucous tissue of the esophagus.

Causes of bile reflux from the duodenum:

Tumors of the abdominal organs. They cause mechanical compression of the duodenum. Under pressure, bile overcomes protective valves that prevent the physiological release of fluids.
Pregnancy. The fetus compresses the organs and has a mechanical effect on the intestines. Because of this, fluids leave the intestines and enter the stomach.
Medicines. One of the reasons affecting intestinal motility. Taking antispasmodics and muscle relaxants reduces the muscle tone of the protective sphincter. Due to weakening of the tone, a lumen is formed through which bile passes.
Excess weight and systematic overeating. As a result of obesity, internal organs become displaced. This leads to a pathological opening of the intestinal valve.
Operations. Pathology occurs when the sphincter muscle fibers are cut. After tissue fusion, a deformation of its shape remains, which leads to dysfunction of the organ.
Chronic duodenitis. A disease that is accompanied by inflammation of the mucous membrane of the duodenum. Because of this, tissue swelling occurs. The intestinal lumen narrows significantly, which slows down the passage of food. Under pressure, the contents return to the stomach.
Reflux after gallbladder removal. This situation is called postcholecystectomy syndrome. In this case, the amount of bile is produced in large quantities. It is able to leave the intestine and enter the stomach. Bile reflux often occurs after physical work. There is a risk of developing chronic gastritis.
Cirrhosis of the liver.
Sleeping on the left side after eating.
Abuse of alcohol or coffee.

Symptoms

The reflux of bile into the stomach and esophagus itself is not a symptom of the disease. This situation also happens in healthy people. A pathological process is considered to be a long course of reflux and its constant relapses.

Symptoms of the disease:

Painful sensations in the abdomen. This indicates the development pathological processes organs gastrointestinal tract. There will be no clear localization of pain.
Heartburn. The stomach begins to spasm when bile enters. It goes into the esophagus, and then into oral cavity. Irritation of the mucous membrane occurs. This process is accompanied by a burning sensation behind the chest.
Gas formation. Accompanied by an unpleasant odor from the mouth. Sometimes the belching takes on a bitter taste.
Vomit.
Plaque on the tongue.
Feeling of heaviness in the stomach.

In children early age Reflux is manifested by excessive regurgitation after feeding. This may be due to congenital anatomical feature Gastrointestinal tract. In this case, it is necessary to feed the child in small portions. Severe intestinal obstruction is eliminated surgically.

Treatment

The disease is a syndrome that combines several symptoms simultaneously. It is necessary to eliminate the cause of the disease, but not its symptoms. Treatment is carried out through medications or surgery.

Drug therapy:

Drugs that accelerate intestinal motility. Selective agents allow you to speed up the emptying of the intestines from contents. This will prevent the accumulation of bile and its release beyond the duodenum.
Reducing acidity. Proton pump inhibitors reduce acid levels in gastrointestinal fluids. This allows you to reduce trauma to the mucous membrane when throwing bile. The most popular drugs in this group are esomeprazole and rabeprazole.
Ursofalk. The drug changes structure bile acid to more watery. You need to take 250 mg per day. Taking tablets is indicated when constant burping and vomiting. You should also follow a diet so as not to burden the gastrointestinal tract during periods of weakened acidity.
Antacids. Their effect is similar to that of proton pump inhibitors. Antacids are cheaper but provide less long-term relief.

The advanced form of the disease is treated with surgery. An operation is prescribed if a large number of bile. First you need to undergo drug therapy. If it doesn't help, then apply surgical intervention. Before the operation, gastroduodenoscopy is prescribed. This study allows you to determine the extent of the lesion and choose the tactics of manipulation.

Intestinal laparoscopy

Surgical intervention:

Laparoscopy. This is a modern method of surgery that is performed without tissue incisions. The doctor performs all manipulations through punctures, so trauma to the intestines is minimal. The laparoscope is the main instrument in this operation. This is a kind of telescopic tube that displays images on a screen. The tool has 10 mm in diameter. After the manipulations, sutures are applied using a self-absorbing thread.
Open surgery. Prescribed in the presence of severe intestinal obstruction. The doctor cuts into the duodenum and manually removes the tumor. This method requires care to avoid damaging the intestinal valves. If this happens, the bile will continue to come out. At the end, a sealed seam is applied. It must be applied so that the contents of the intestines do not leak out. If the seam is leaky, the person’s well-being will deteriorate in the near future after the operation.

Treatment with folk remedies

Folk remedies will help get rid of many unpleasant symptoms that appear when bile is released. Such therapy can only be used after a medical examination.. It is necessary to identify the source of the disease before starting treatment.

Herbal compositions:

A remedy that reduces pain and inflammation of the mucous membranes. You will need to mix lemon balm leaves, crushed flax seeds, chamomile, licorice root and motherwort in equal proportions. Pour 500 ml of boiling water over the resulting mixture. Evaporate in a water bath for 10 minutes. Before use, it is necessary to strain the composition and cool. Take 1/4 cup four times a day.
Mix in equal proportions the root of the calamus, the fruit of anise, the herb of white damselfish, oregano, mint and fireweed leaves. All ingredients are mixed and crushed. Fill with water at room temperature. Leave to infuse dark place about two hours. After this, the composition is heated for 20 minutes in a water bath. Before your appointment medicinal composition should be cooled. The product allows you to reduce the amount of bile in the stomach and reduce its harmful effects on the mucous membranes.
Mix knotweed root, plantain leaves, grass in equal proportions shepherd's purse, medicinal dandelions, oregano herb, chamomile and yarrow inflorescences. Brew the resulting mixture for 20 minutes. Take a quarter glass on an empty stomach three times a day.

Recipes for treating reflux:

Potatoes can relieve heartburn. It must be grated on a fine grater. Squeeze the resulting mass through cheesecloth into a glass. Potato juice should be drunk on an empty stomach. You can add sugar to tone it down bad taste juice
Soda. Allows you to get rid of heartburn literally immediately after use. Soda affects the acidity of bile, completely depriving it of its properties. You need to mix two tablespoons of baking soda in a glass of water. You should drink in small portions. Apply directly during the reflux of bile into the esophagus and stomach. Soda must be consumed with caution: it quickly develops gastric ulcers.
Dill infusion to relieve inflammatory processes. Crush two teaspoons of dill, pour into a glass hot water. Cover the vessel with the infusion with a lid and leave for two hours. The decoction must be strained before taking. Drink one tablespoon before meals.

Diet

Diet is a necessary part of therapy for reflux. The first days after surgery, only light chicken broth is allowed. It should be non-greasy. By the end of the week, it is added to the diet vegetable puree. The menu expands as you recover.

Foods prohibited for reflux:

any citrus fruits;
cranberry;
tomato juice;
sour fruits;
fresh vegetables;
fried potatoes;
raw onion;
pork and beef;
fatty dairy products;
pasta;
alcohol, tea and coffee;
seasonings;
sauces;
fatty desserts.

List of permitted products:

lean poultry;
bananas;
boiled potatoes;
carrot;
beans;
peas;
low-fat dairy products;
dry bread;
rice (but not pilaf).

break meals into small portions throughout the day;
chew food thoroughly;
the last meal should be three hours before bedtime;
sleep on a high pillow;
do not drink drinks at night;
no smoking;
drink a small amount of warm water;
avoid stress.

Dyskinesia of the gallbladder and biliary tract is a disease in which there is a violation of motility (movement) and tone of the gallbladder, as well as its ducts.

Some statistics

Among all diseases of the gallbladder and bile ducts, dyskinesia accounts for 12.5%.

Women suffer from this disease approximately 10 times more often than men. What is associated with the characteristics of hormonal and metabolic processes female body(eg, changes during pregnancy, taking oral contraceptives). Women are especially susceptible to the disease young asthenic physique.

Among children, adolescents are the most frequently affected.

In 2/3 of all cases this is secondary disease, which develops against the background of damage to the gastrointestinal tract (colitis, peptic ulcer of the duodenum and/or stomach, pancreatitis, gastritis).

The most common (about 60-70% of all cases) is the hypotonic form. IN modern medicine the disease was first described by surgeons in 1903-1909, who operated on a patient with severe pain in the right hypochondrium. However, upon opening abdominal cavity, they found no stones or inflammation in the gallbladder. After which the disease began to be carefully studied by general practitioners.

However, even in ancient times it was noticed that there is a connection between a person’s negative emotions and disease of the gallbladder, as well as its ducts. Therefore, such people were called “bilious.”

In addition, everyone knows about the four types of temperament that were described in medical treatises by ancient doctors.

For example, anger and irritability indicate an excess of energy at the point of the gallbladder - a hypertensive variant of dyskinesia (choleric type of temperament). That is, the wall of the gallbladder is tense and contracts strongly.

While bitterness, lethargy and a tendency to depression indicate a lack of energy at the point of the gallbladder - a hypotonic variant of dyskinesia (melancholic type of temperament). That is, the wall of the gallbladder is sluggish and contracts poorly.

Anatomy and physiology of the gallbladder

Gallbladder - hollow organ. It is usually located on the right side of the upper abdomen, approximately at the level of the middle of the lower hypochondrium (below the last rib).

The length of the gallbladder ranges from 5 to 14 cm, and the width from 3 to 5 cm. Its capacity on an empty stomach ranges from 30 to 80 ml. However, when bile stagnates, its volume increases.

Normally, the gallbladder has an elongated pear-shaped shape (with wide and narrow ends). However, sometimes its shape is quite bizarre: spindle-shaped, elongated, doubled, with a bend or internal jumpers, and so on.

The gallbladder has three parts - the bottom, body and neck (narrow part). The cystic duct departs from the cervix, which subsequently connects with the hepatic duct, forming the common bile duct. In turn, the common bile duct opens into the cavity of the duodenum (12 PC) in the area of the papilla of Vater, which is surrounded by the sphincter (muscle ring) of Oddi.

The structure of the gallbladder wall

The mucous membrane consists of epithelial and various glandular cells that produce mucus. It forms multiple folds that form the Lutkens-Martynov sphincter at the neck of the gallbladder, which prevents the release of bile until certain stages of digestion occur.

Muscularis, which mainly consists of smooth muscle fibers arranged circularly (circularly)

The connective tissue membrane covers the outside of the gallbladder. It contains blood vessels.

Tasks of the gallbladder

Accumulation, concentration and storage of bile produced in the liver

Release of bile into the lumen of the duodenum as needed

Bile is produced continuously by liver cells (from 0.6 to 1.5 liters per day). Then it enters the intrahepatic ducts, and from them into the gallbladder. In the gallbladder, bile is concentrated due to the absorption of excess water, sodium and chlorine from it by the epithelial cells of the mucous membrane.

The mechanism of bile secretion from the gallbladder

The most important neurohumoral factors regulating this complex process are:

The autonomic nervous system (sympathetic and parasympathetic divisions), which regulates the functioning of almost all internal organs
Normally, when the vagus nerve (vagus), which provides sensory and motor innervation to most internal organs, is activated, the gallbladder contracts and the sphincter of Oddi relaxes. If there is a violation of the coordination in the work of the sympathetic and parasympathetic divisions vegetative nervous system this mechanism is disrupted.
Intestinal hormones (motilin, cholecystokinin-pancreozymin, gastrin, secretin, glucagon), which are produced in the gastrointestinal tract during meals
When exposed to cholecystokinin in normal doses, the gallbladder contracts and the sphincter of Oddi relaxes (in large doses, the motility of the gallbladder is inhibited). Gastrin, secretin, glucagon have the same effect as cholecystokinin, but less pronounced.
Neuropeptides (neurotensin, vasointestinal polypeptide and others) are a type of protein molecule that has the properties of hormones
They prevent the gallbladder from contracting.
As a result of the close interaction of these factors, during food intake the muscular layer of the gallbladder contracts 1-2 times, increasing the pressure in it to 200-300 mm of water column. Therefore, the Lutkens-Martynov sphincter relaxes, and bile enters the cystic duct. Next, the bile enters the common bile duct, and then through the sphincter of Oddi into the 12th PC. When diseases occur, this mechanism is disrupted.

The main functions of bile in digestion

Creates the necessary conditions in 12 PCs for the loss of pepsin (the main enzyme gastric juice) its properties
Participates in the breakdown of fats, promoting their absorption, as well as the absorption of fat-soluble vitamins (A, E, D)
Improves motor function(motor skills) small intestine and increases appetite
Stimulates mucus secretion and the production of intestinal hormones: motilin, cholecystokinin-pancreasemin and others
Activates enzymes necessary for the digestion of proteins (trypsin and lipase - enzymes of pancreatic juice)
Promotes the proliferation of epithelial cells of the intestinal mucosa
Has antibacterial properties, which are weakened by stagnation of bile

Causes of gallbladder dyskinesia

There are primary and secondary dyskinesia of the gallbladder and biliary tract (GBD), depending on the causes that led to the disease.

Also currently being considered is the theory that there is a disruption in the functioning of liver cells, so they initially produce bile, the composition of which has already been changed.

Primary dyskinesia of the gallbladder and biliary tract

At the onset of the disease there are only functional disorders, which are not detected by research methods (ultrasound, x-ray). However, as the disease progresses, structural changes develop in the gallbladder and its ducts.

The most common causes of primary VAVP

Secondary dyskinesia of the gallbladder and biliary tract

Occurs against the background of already developed diseases or conditions. The changes are clearly visible with the following research methods.

The most common causes of secondary VAVP

Symptoms of gallbladder dyskinesia

They depend on the type of disturbance in the motor activity of the gallbladder and its ducts.

Types of diesel fuel

Hypotonic (hypomotor) dyskinesia develops with insufficient contractility of the gallbladder and its ducts. Occurs in patients with a predominance of the tone of the sympathetic nervous system (normally dominant during the day), which reduces the tone and motor activity Gastrointestinal tract, as well as the gallbladder and its ducts. Most often this form of the disease affects people over 40 years of age.
Hypertonic (hypermotor) dyskinesia develops with increased contractility of the gallbladder and biliary tract. It occurs in people with a predominance of the parasympathetic nervous system (normally dominant at night), which enhances the motor function and tone of the gastrointestinal tract, as well as the gallbladder and its ducts. Most often, teenagers and young adults suffer from this form of the disease.
Hypotonic-hyperkinetic dyskinesia is a mixed variant of the course of the disease. The patient has symptoms of both hypotonic and hypertensive forms of dyskinesia in varying degrees expressiveness.

Signs of gallbladder dyskinesia

Symptom	Manifestations	Development mechanism
Hypotonic dyskinesia
Pain	Constant, long-lasting, dull, bursting, aching. It is located in the right hypochondrium, but has no clear localization. As a rule, it intensifies during meals or immediately after it.	The bottom of the gallbladder is stretched, which is caused by stagnation of bile due to insufficient production of cholecystokinin in the gastrointestinal tract.
Belching is an involuntary release of gas from the stomach into the oral cavity with a characteristic sound and sometimes smell	It usually occurs after meals, but sometimes between meals.	The regulation of the gallbladder by the nervous system is disrupted, so the patient makes more frequent swallowing movements, swallowing air while eating. As a result, the pressure in the stomach increases. Therefore, the muscular wall of the stomach contracts, and the tone of the outlet sphincter decreases - and air is expelled.
Nausea and/or vomiting (sometimes with an admixture of bile, if there is a reflux of bile from 12 PCs into the stomach)	Occurs more often after meals and dietary errors: intake fatty foods, fast food, overeating and others	Due to impaired motor skills, the nerve receptors of the gastrointestinal tract are irritated, which send an impulse to the vomiting center (located in the brain). From it, impulses are sent back to the gastrointestinal tract and diaphragm, leading to contraction of their muscles and the occurrence of reverse movements. Also with bacterial and viral infections In helminthiasis, the vomiting center is irritated by the products of their vital activity (toxins).
Bitterness in the mouth (most typical for the hypotonic variant of dyskinesia)	Mainly in the morning, after meals or physical activity.	Motor skills are impaired, and the gastrointestinal sphincters relax. The result is antiperistaltic movements (food moves in the opposite direction). Therefore, bile from 12 PCs enters the stomach, then into the esophagus, then into the oral cavity.
Bloating (flatulence)	There is a feeling of abdominal distension at the height of digestion, which is often accompanied by pain. After the gas passes, the pain subsides.	Digestion is impaired due to insufficiency of bile. As a result, the processes of decay and fermentation in the lumen of the small intestine intensify. Therefore, gases are released in large quantities.
Decreased appetite		Bile stagnates due to poor contractility of the gallbladder. Therefore, it is not sufficiently released into the lumen of 12 PCs.
Diarrhea (rare)	Typically occurs shortly after eating.	If there is insufficiency of bile, digestion is disrupted: proteins, fats and carbohydrates are poorly broken down. As a result, the cells of the mucous membrane of the small intestine are irritated, which increase the secretion of water, sodium and chlorine. At the same time, their absorption decreases. Therefore, the volume of the food bolus increases, and its movement through the intestines accelerates.
Constipation (occurs frequently)	There is no stool for more than 48 hours or there is systematic insufficient bowel movement.	It occurs as a result of a slowdown in the movement of the food bolus through the intestines due to spasm or relaxation of the tone of the intestinal wall. Therefore, the reabsorption of water increases. At the same time, feces decrease in volume, and their density increases. In addition, there is a lack of bile acids (contained in bile), which normally have a stimulating effect on the intestinal muscles.
Obesity	Develops during a long course of the disease or is the cause of its occurrence	Due to insufficiency of bile, the process of digestion and breakdown of fats is disrupted. Therefore, the production of insulin by the pancreas increases. As a result, the synthesis of fats and their accumulation in fat cells of subcutaneous fat, as well as on internal organs, increases.
	Decreased heart rate, decreased blood pressure, redness of the facial skin, sweating, increased salivation.	The development mechanism is complex and not fully understood. However, it is believed that there is low resistance of the heart and blood vessels to stress. Therefore, during it, less oxygen reaches the brain, organs and tissues. As a result, the balance between the sympathetic and parasympathetic nervous systems is disrupted, and the internal organs receive incorrect commands to work.
Hypertensive dyskinesia
Pain	The pain is intense, colicky, occurring acutely in the right hypochondrium after stress or emotional stress (most often), errors in diet, or physical activity. The pain lasts from 20 to 30 minutes and repeats several times during the day. Often it radiates from the right side to the back, shoulder blade or arm. However, sometimes the pain radiates to the left (to the region of the heart), simulating an attack of angina. In the period between attacks, as a rule, a feeling of heaviness in the right hypochondrium persists.	The pain is associated with a sharp contraction of the gallbladder during increased tone sphincters of Oddi and Lutkens-Martynov, so bile does not drain.
Decreased appetite	Bile is a stimulant of appetite, intestinal motility and the production of intestinal hormones.	The gallbladder is in a spasmodic state and contracts excessively. However, in this case, the sphincters responsible for the timely flow of bile into the 12 PCs do not work or relax between meals. Therefore, bile in insufficient or large quantities enters 12 PCs.
Loss of body weight (develops frequently)	The subcutaneous fat layer thins and decreases muscle mass.	Due to the secretion of bile between meals, foods are poorly broken down. Therefore, proteins, carbohydrates, fats, vitamins and minerals are absorbed in insufficient quantities. In addition, due to decreased appetite, patients do not eat enough.
Nausea and vomiting	They often accompany the attack of biliary colic itself, but outside the attack they are usually absent.	Gastrointestinal tract receptors are irritated due to impaired motility, so nerve impulses are sent from them to the vomiting center (located in the brain). Impulses are sent back from it to the receptors of the gastrointestinal tract and diaphragm, intercostal muscles, so they contract, expelling gastric contents.
Diarrhea (occurs frequently)	As a rule, it occurs soon after eating or during an attack.	Bile enters the lumen of the small intestine in large quantities between meals (asynchronously). As a result, bile acids found in bile inhibit absorption and also increase the secretion of water and salts (sodium, chlorine), causing an increase in volume feces and accelerating their movement through the intestines.
Symptoms of dysfunction of the autonomic nervous system (the center is in the brain)	During an attack, sweating, rapid heartbeat, general weakness, headache, increased blood pressure. Outside of an attack, irritability, fatigue, sleep disturbances, increased blood pressure, and aching sensations are noted. pain in the heart area, rapid heartbeat and other symptoms.	The mechanisms of development have not been fully established. It is assumed that the basis of the disease is the lability of the nervous system due to weakness of the heart and blood vessels, which, at times of stress, poorly supply blood to organs, tissues and the brain. Therefore, the autonomic nervous system gives incorrect commands to the vessels, gastrointestinal tract, internal organs, as well as the gallbladder and its ducts.
Signs that can develop in both forms of ADHD with the same manifestations
Jaundice skin and visible mucous membranes (rarely develops)	Appears when there is a severe violation of the outflow of bile (stone, narrowing of the common bile duct). In this case, the feces are colorless, and the urine is dark in color.	When bile stagnates, bilirubin (a pigment contained in bile) is absorbed into the blood and spreads throughout the body, settling in the skin and mucous membranes, giving them a jaundiced tint. Since bile does not enter the gastrointestinal tract, the stool becomes colorless.
Plaque on the tongue (can also develop with other diseases: colitis, gastritis and others)	It may be white or with a yellowish tint when bile flows back (most often occurs with the hypotonic variant of dyskinesia). If the plaque is severe, patients may experience a feeling of discomfort on the tongue and a dull sense of taste.	Appears as a result of disruption of keratinization processes (transformation of mucosal cells into scales) and desquamation of the epithelium from the surface of the tongue. Occurs due to disruption of transfer nutrients to the tongue.

Diagnosis of dyskinesia of the gallbladder and biliary tract

Objectives: to determine the type of biliary dyskinesia and identify concomitant diseases that may support their dysfunction.

Ultrasound examination (ultrasound)

Allows you to determine the shape and presence congenital anomalies development of the gallbladder, as well as the degree of its emptying.

Basic X-ray examinations

They are the leading methods in diagnosing diseases of the gallbladder and bile ducts.

Cholecystography
It is based on the oral administration of drugs containing iodine (Biliselectan, Kholevid, Yodobil and others).
Indications
- Studying the structure and identifying the presence of stones in the gall bladder
- Study of the excretory and storage (concentration) function of the gallbladder, as well as its distensibility.
Flaw
It is impossible to determine the condition of the bile ducts, since they are not visible on the photographs.
Methodology
On the eve of the study at 19.00, the patient takes two raw eggs. Starting from 21.00, he takes a contrast agent at intervals of 30 minutes with water. The contrast agent is absorbed into the blood in the intestines and then released by liver cells.
In the morning on an empty stomach, several overview photographs of the right side of the abdomen are taken. Then the patient is offered a choleretic breakfast (usually an egg yolk) and a series of photographs is again taken.
Interpretation of results
In the hypertensive form, the gallbladder sharply and quickly contracts from its original volume: by 75% in the first 5-15 minutes, by 90% in the next 1.5-2 hours. Then long time is in this state, without emptying due to the spasm of the sphincter of Oddi.
In the hypotonic form, the gallbladder is enlarged, and its contraction after a choleretic breakfast is very slow from the initial volume: by 20-30% within 15 minutes and remains so for three to four hours.

Infusion cholecystography
The method is based on intravenous administration contrast agent, containing iodine, which accumulates in the gallbladder and its ducts.
Indications
Determination of sphincter of Oddi tone.
Methodology
The patient in the morning on an empty stomach in the X-ray room on the table is injected intravenously with a solution of Bilignost for 15-20 minutes. And at the same time a morphine solution is administered to artificial reduction sphincter of Oddi. After 15-20 minutes, a picture is taken showing the gallbladder and its extrahepatic ducts. The normal width of the common bile duct is 3-7 mm.
Interpretation of results
In case of insufficiency of the sphincter of Oddi, the contrast agent enters 12 PCs 15-20 minutes after administration when the width of the common bile duct is 9 mm or more.

Cholangiography
It is carried out to examine the bile ducts after the injection of a contrast agent into them.
Indications
- Suspicion of severe narrowing of the bile duct
- Yellowness of the skin and mucous membranes caused by blockage of the bile duct with a stone or compression by a tumor
- Severe and prolonged pain syndrome
Basic methods for diagnosing dyskinesia

If necessary, during the procedure, small stones are removed from the lumen of the common bile duct, and a tube is installed into it to facilitate the outflow of bile.

Duodenal sounding

The goal is to study bile, as well as the function of the gallbladder and its ducts,

On an empty stomach, a 12 PC probe is inserted into the patient through the oral cavity and stomach. Then he is placed on his right side and bile is obtained in portions:

The first phase (“A” portion) is a mixture of pancreatic juice and 12 PCs. It is collected from the moment of insertion of the probe until the introduction of the stimulator (magnesium sulfate solution). Normally, 15-20 ml of golden-yellow secretion is obtained in 10-20 minutes.
The second phase is the period of time from the moment of administration of the stimulant (choleretic) until the appearance of the next portion of bile (closed sphincter of Oddi phase). Normal duration is from 3 to 6 minutes.
The third phase is obtaining the contents of the cystic duct. Normally, about 3-5 ml of secretion is obtained in 3-5 minutes.
The fourth phase (portion “B”) - obtaining the contents of the gallbladder. The bile is thick and dark brown in color. Normally, 30 to 50 ml of bile is released in 15-25 minutes.
The fifth phase (portion “C”) is the hepatic phase, during which light yellow liquid bile is obtained from the intrahepatic bile ducts.

Interpretation of results

Treatment of diseases that lead to the development of dyskinesia is carried out:

Helminthic infestation (for example, giardiasis or opisthorchiasis)
Peptic ulcer (use of two or three component regimens)
Fighting infection (prescribing antibiotics)
Removing gallstones and treating other ailments

Outside the period of exacerbations:

Apply mineral water: in the hypertonic version - waters of low mineralization (Slavyanovskaya, Narzan, Essentuki 2 or 4), in the hypotonic version - waters of high mineralization (Arzani, Essentuki 17).

It is recommended to stay in a sanatorium with a focus on treating diseases of the digestive system.

Diet for gallbladder dyskinesia

Compliance with the diet is the basis for success in treating the disease; it is prescribed for a long time (from 3-4 months to a year).

Target- sparing the liver, biliary tract and gastrointestinal tract, as well as normalizing their function.

During an exacerbation of the disease with any type of dyskinesia, the following are excluded:

Fatty meats (goose, duck) and fish (sardine, sturgeon, halibut)
Smoked, fried, fatty, salty, sour and spicy dishes
Alcohol, rich broths, seasonings, onions, garlic, radishes, sorrel
Cream confectionery, muffins, chocolate, carbonated drinks, cocoa, black coffee
Products that increase gas formation: peas, beans, Rye bread
Cream, whole milk
Canned foods and marinades

It is recommended to eat fractionally (5-6 times a day) and in small portions.

Cooking:

Products are boiled, baked or steamed: meatballs, steamed cutlets, and so on.

In the first days of an exacerbation, it is recommended to consume foods in liquid pureed form or minced through a meat grinder. As it disappears acute symptoms this is not required.

Features of the diet for hypomotor dyskinesia

Allowed for consumption

Yesterday's rye bread or wheat flour second class
Lactic acid products no more than 6% fat: sour cream, cottage cheese, kefir
Lean meats (beef) and fish (hake, pollock, pike perch), poultry (chicken)
Vegetables in any form
No more than one yolk per day
Boiled low-fat varieties sausages and sausages
Vegetable fats and butter
Honey, sugar, caramel, marmalade, pastille
Fruit and vegetable juices, as well as non-acidic fruits and berries (apples, apricots and others)
Tea, coffee with milk
Any cereals and pasta
Vegetable broth soups

Features of the diet for hypermotric dyskinesia

The same foods are allowed to be consumed as for hypomotor dyskinesia, but the following are excluded:

Sausages and sausages (even boiled)
Sugar, caramel
Pork, veal
Egg yolk
Fresh berries, vegetables and fruits

Traditional methods of treating dyskinesia

A good addition to the main treatment with medications, especially after reducing the acute symptoms of the disease.

Infusions and decoctions	How to prepare and take	What effect to expect
Hypotonic dyskinesia
Decoction of immortelle flowers	3 tbsp. Pour the flowers into an enamel bowl and pour a glass of boiling water. Then heat in a water bath for 30 minutes, stirring constantly. Remove from heat, let cool, and then strain. Take half a glass 20-30 minutes before meals. Course - 2-3 weeks.	Strengthens gallbladder contraction and improves bile flow Normalizes the composition of bile Improves the functioning of the gastrointestinal tract Locally disinfects
Infusion from corn silk	1 tsp Pour a glass of boiling water over the crushed raw materials and let it brew for 30 minutes. Then express and take 3 tbsp. l. three times a day half an hour before meals. Course - 2-3 weeks.	Liquefies bile and eliminates its stagnation Reduce blood bilirubin and cholesterol levels
Oregano herb infusion	Pour 2 tbsp. crushed raw materials 200 ml boiling water. After 20-30 minutes, express. Take the entire infusion throughout the day in three doses 30 minutes before meals. Course - 1 month or more.	Strengthens the motor activity of the intestines and bile ducts Provides local anti-inflammatory and choleretic effect Normalizes the functioning of the nervous system
Hypertensive dyskinesia
Peppermint infusion	2 tsp peppermint and pour 200 ml of boiling water. Let it sit for 30 minutes, then express. Take 1/3 cup 20 minutes before meals twice a day. Course - 3-4 weeks.	Reduces pain and nausea, Relaxes the muscles of the bile ducts and sphincters, promoting the outflow of bile Improves digestion and appetite Has a local anti-inflammatory effect
Licorice root decoction	2 tsp crushed raw materials, pour 200 ml of boiling water, place in a water bath for 20 minutes. Let cool, then decant and bring to original volume. boiled water. Take 1/3 cup 30 minutes before meals three times a day. Course - 2-3 weeks.	Relaxes the smooth muscles of the gallbladder and its ducts
For both types of dyskinesia
Chamomile flower decoction or tea	1 tsp dry chamomile flowers pour 200 ml of boiling water. After 3-5 minutes, express. Consume for a long time three times a day as tea.	Reduces bloating Improves the functioning of the gastrointestinal tract Helps reduce or eliminate belching Normalizes the functioning of the nervous system, helps fight insomnia Accelerates the healing of wounds on mucous membranes (ulcers, erosions) Fights locally against pathogens Increases appetite

The backflow of bile into the stomach is called reflux disease. The pathology is dangerous due to the development of serious complications associated with deep damage to the mucous membranes of the stomach, up to perforation of ulcerative lesions and perforation of the walls of the organ.

Treatment of bile reflux into the stomach is always comprehensive, aimed at relieving symptomatic manifestations and eliminating true reflux. In severe clinical situations, the cause is eliminated surgically.

Why is bile thrown into the stomach and what is the treatment? The main cause of reflux is impaired muscle tone. Provoking factors may be injuries, abnormal development of parts and organs of the gastrointestinal tract, constant exposure to aggressive foods.

Clinicians distinguish two main treatment directions after establishing a final diagnosis - surgical intervention and conservative therapy. Both methods often complement each other. In the vast majority, conservative treatment with medications is sufficient. How to remove bile in the stomach and get rid of pathology?

Drug therapy

To treat the reverse reflux of bile secretions into the stomach, a wide range of medicines who are filming unpleasant symptoms and may affect the reason for treatment.

An essential aspect of successful therapy is compliance special diet, which reduces the digestive load, normalizes the secretion of bile and ensures its normal distribution along the hepatobiliary tract. If there is a lot of bile in the stomach, what should you do?

Drugs to reduce proton pump secretion

A proton or proton pump (pump) is a certain enzymatic protein that is involved in the production of hydrochloric acid, which is so necessary for normal digestion.

If there is too much protein or proton pump production, acid begins to be produced in increased volume, which negatively affects the condition of the mucous membranes of the gastrointestinal tract as a whole. Inhibitors reduce enzyme activity, normalize the secretion of hydrochloric acid and minimize traumatic damage to the mucous membranes. The following drugs are usually prescribed:

Note! Drugs for the treatment of bile in the stomach have many analogues, so it is almost impossible to independently understand the effectiveness of the drugs without consulting a doctor. Proton pump inhibitors have a whole range of contraindications, including pregnancy and lactation, children under 12 years of age (according to indications), and individual intolerance.

Antacids

Antacids are “standby” drugs in the first aid kit of every patient suffering from various diseases upper parts of the digestive system. Antacids quickly neutralize acidity in the stomach, reduce the intensity of heartburn, alleviate the patient’s condition during exacerbation of gastritis, peptic ulcer stomach, gastroesophageal reflux (reflux of gastric juice into the esophagus) and reflux of bile secretion into the stomach. Popular medications to reduce symptoms include the following:

Phosphalugel;
Almagel And Almagel A(with an anesthetic component);
Maalox;
Gastracid;
Topalkan;
Gaviscon.

For emergency assistance you can use unconventional methods. Among the folk remedies, baking soda, magnesium carbonate, and burnt magnesia are considered effective.

Antacids are not used in pediatric practice for the treatment of children under 3 months. The use of the drug during pregnancy and lactation is unacceptable.

Important! Contraindications to the prescription are more conditional and can be used in patients of any amnestic group as prescribed by a doctor.

Prokinetic agents in the fight against reflux

Prokinetics are a group of drugs that ensure normal motility of the gastrointestinal tract and stimulate the rapid evacuation of the food bolus through the digestive tract. The prescription of prokinetics is due to stagnation of food, heartburn, impaired peristalsis and the appearance of constipation due to the reflux of bile into the stomach. The main agents with prokinetic properties are the following:

Motorix,Motilium, Motinorm;
Bromopride, Raglan, Cerucal;
Propulsid, Coordinax, Fractal, Zelmak.

Many drugs for the treatment of gastroenterological diseases have prokinetic properties, which is important to consider when prescribing drug therapy. Exceeding the dose can lead to diarrhea and persistent diarrhea.

The combination of prokinetics with Erythromycin, Ketoconosal, Telithromycin and other inhibitors of the CYP3A4 isoenzyme is unacceptable. Prokinetics are contraindicated in internal bleeding, hypersensitivity to the components of the drug during pregnancy and lactation.

Antispasmodics

Antispasmodic drugs are prescribed for spastic pain in the abdomen and stomach to reduce smooth muscle tone and normalize digestion. The main antispasmodics are the myotropic drugs Papaverine and No-Shpa (analogue of Drotaverine). Papaverine is widely used for bile stagnation in choleretic ducts caused by spasm of muscle structures. Papaverine is widely used in pediatric practice and is suitable for the treatment of reflux in young children.

Drotaverine has a similar effect on the body and is prescribed for pain in the hepatobiliary region and stomach. Both drugs should not be taken when renal failure, individual intolerance remedies for glaucoma and oncological tumors of any location. Other drugs include:

Papazole;
Biospa;
Neobutin;
Duspatalin;
Mebeverine;
Odeston;
Simethicone.

Important! Despite the widespread use of antispasmodic drugs, it is unacceptable to use medications for the treatment of reflux disease in children and adults without a doctor’s prescription.

Choleretic agents

Drugs from the group choleretic drugs prescribed for congestion, when bile stagnates in the lumens bile ducts, conditions are created for the development of reflux disease. The active components of the drugs stimulate the flow of bile secretion through the ducts, preventing stagnation and eliminating unpleasant symptoms. By effective means are:

Odeston;
Nikodin;
Flamin;
Oxaphenadime;
Hofitol;
Pancreazim.

Choleretic drugs have multiple classifications, so choose necessary remedy important with the help of your doctor. The doctor will also take into account the cost of drugs in order to choose an inexpensive one that fits the patient’s budget. Medicines have significant side effects: nausea, increased abdominal pain, stool upset. You should not take medications if you have an individual intolerance, pregnancy or lactation, unless otherwise indicated.

Hepatoprotectors

Hepatoprotectors help restore liver tissue and normalize the function of the entire hepatobiliary system as a whole. Hepatoprotectors prevent the transformation of bile secretions into a water-soluble form, relieve unpleasant symptoms: bitterness in the mouth, nausea, bad smell from the mouth, heartburn. Main effective drugs consider:

Ursofalk;
Ursosan;
Heptral;
Hofitol;
Silimar;
Allohol;
Essentiale-N;
Karsil.

Hepatoprotectors are contraindicated in case of cholelithiasis, acute liver failure, with cirrhotic changes in liver tissue. During pregnancy and childhood taking hepatoprotectors requires special indications when the expected benefit outweighs the potential harm.

Note! All medications require careful analysis when prescribing. It is important to correctly combine the active ingredients, follow the correct dosage and dosage regimen. If you do not follow the doctor's recommendations drug treatment will only provide temporary results and patients will require more serious intervention.

Useful video

How to get rid of bile reflux is discussed in this video.

Radical treatment methods

How to treat the reflux of bile into the stomach with surgery? Duodenal reflux develops against the background of almost any organic pathology of the gastrointestinal tract. If drug therapy does not bring positive dynamics or is impossible, then resort to surgical intervention. Today there are several methods of performing the operation:

With effective treatment, the function of the gallbladder, the hepatobiliary system as a whole and the gastrointestinal tract is restored. Rehabilitation involves long-term compliance therapeutic diet, drug therapy and some restrictive instructions. In some cases, the diet is lifelong.

Traditional methods

Others effective methods there is no treatment. From traditional medicine known choleretic herbs: St. John's wort, thyme, immortelle, plantain and others, however, their action can only relieve unpleasant symptoms, but not eliminate the cause of the disease.

Traditional medicine looks much better during the rehabilitation period or after effective drug treatment.

At home, you should also follow a diet that excludes aggressive foods, carbonated waters (including mineral water, sweet drinks), and alcohol.

The reflux of bile into the stomach requires immediate treatment. Symptoms of bile flow disturbance appear immediately and are characterized by intensity and persistence. Psycho-emotional disorders develop against the background of physical discomfort. Timely treatment prevents the development of complications and the need for surgery in 35% of all clinical cases.

Bile reflux into the stomach: treatment folk remedies is it acceptable? Many people ask these questions. No, this serious disorder should be treated by a professional gastroenterologist. As a result of spasm of the gallbladder, bile moves from the liver upward into the stomach and esophagus. During normal functioning of the gallbladder, bile enters the duodenum, where it helps digest food, and then moves to the lower intestines as part of a food coma.

How does the violation manifest itself?

Bile acids are aggressive chemicals; if they constantly come into contact with the gastric mucosa, they can provoke the development of gastritis. What do victims of bile reflux into the stomach complain about:

the appearance of a bitter and disgusting taste in the mouth;
heartburn;
heaviness, discomfort, pain in the epigastric region;
nausea, vomiting of bitter and yellow contents;
strong thirst;
sharp pain and feeling of fullness in the abdomen;
a bitter and yellowish coating forms on the tongue.

If these unpleasant symptoms recur regularly, then the help of a gastroenterologist is required. At acute pain and a feeling of tension in the abdomen, you should visit a specialist urgently. A single release of bile can be caused by:

smoking on an empty stomach;
sleeping on the left side after a heavy meal;
food poisoning;
overeating;
washing down fatty foods with cold water;
eating very salty, hot and spicy foods;
side effects of medications that relax the stomach muscles;
physical activity immediately after eating, especially with the body tilted forward.

Signs of bile reflux can be so painful that a person has no choice but to lie horizontally and refuse to carry out current activities. What can be done to urgently relieve the victim’s well-being:

drink plenty of warm water, at least 2 glasses;
take an antacid, for example, Maalox, Almagel or similar;
drink milk.

If bile reflux occurs due to food poisoning, milk should not be consumed; instead, any absorbent drug should be taken, Activated carbon, Enterosgel and the like. In the long term, for a sustainable improvement in well-being you need:

seek examination from a gastroenterologist;
stick to a diet;
eat small meals, do not starve, do not overeat;
normalize the functioning of the liver and gall bladder;
give up alcohol and cigarettes.

The constant release of bile into the stomach leads to gastritis, which causes ulcers. As a result of a violation of the digestive sequence, proper absorption of nutrients becomes difficult, which threatens vitamin deficiency and concomitant diseases. Timely request for medical care will help minimize damage to orgasm.

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What causes the release of bile?

In each specific case, diagnosis should be carried out by a gastroenterologist. Without taking into account all clinical picture it is impossible to say what caused the patient's bile reflux. The most common reasons for this disorder:

gallbladder diseases;
disturbances in liver function;
weak stomach muscles that cannot hold food bolus and bile in lower sections intestines;
stomach fullness;
damage to the pyloric muscles, for example, as a result of surgery;
diseases of the duodenum, duodenitis;
stomach diseases, gastritis.

Effective treatment should be based on a correct diagnosis, therefore it is necessary to treat the stomach with traditional medicine only after consultation with a gastroenterologist. A complex approach to the disease, it suggests prescribing not only remedies to relieve symptoms, but also normalizing the functioning of the digestive system. At risk for gastrointestinal diseases are:

those who eat poorly and irregularly, abuse fried and salty foods with large amounts of flavor enhancers and other food additives;
faces with increased weight bodies;
patients with diabetes mellitus;
suffering from chronic diseases liver;
abusing alcohol, caffeine, nicotine;
patients experiencing great chronic stress, for example, businessmen;
having a hereditary predisposition;
having congenital pathologies stomach and intestines.

Prevention of stomach diseases is based on timely nutrition. Patients over 45 years of age most often suffer from bile reflux, but an unhealthy lifestyle can lead to earlier development of the disease.

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Drug treatment

The patient is prescribed a gentle diet in order not to provoke pathological activity of the gallbladder. Without following a diet, no guarantee of improved well-being can be given. What medications are used to alleviate the condition of the victim:

To normalize secretion and peristalsis, Ranitidine, Cerucal, Omeprazole, Motilium or similar drugs are prescribed.
To reduce the effect of bile, it is recommended to use Almagel, Vikalin, Maalox, Venter, Rennie. These medications form a film on the surface of the stomach, which prevents bile from corroding the mucous membrane and causing gastritis.
To protect the mucous membranes, De-nol, Venter, and Folic acid can be prescribed.
To facilitate the digestion process, enzyme supplements are used, as well as Mezim, Creon, Festal, Pangrol, Panzinorm. A good effect is achieved by using adsorbents, Smecta, Enterosgel, which relieve pain and prevent stomach spasms.
To neutralize bile acid, Omez, Nexium or other proton pump inhibitors are prescribed.
To stimulate peristalsis, Cerucal, Domperidone or similar prokinetics are used. Proper promotion of food coma, normal operation gallbladder and stomach muscles helps prevent the reflux of bile up the esophagus.

Recommendations on the dosage and duration of taking medications are given by a gastroenterologist. If the examination reveals a disease of the liver, gallbladder or stomach, additional medications. Some popular medications, such as Aspirin, have contraindications. If you have diseases of the gallbladder and intestines, you should carefully read the instructions for each medication you plan to use.