Why does bile rise from the stomach. Causes and etiological treatment of bile reflux into the stomach

Bile is a substance that is formed as a result of the secretion of liver cells. Bile contains useful pigments, acids, phospholipids, which are involved in digestion. With the help of it, the intestine normally copes with the reaction of emulsification of fats, with the hydrolysis of lipids, their assimilation. In this area, fat-soluble vitamins and calcium are absorbed with the help of bile.

Normally, the bile fluid from the liver passes through the ducts into the bladder, and from there - at 12- duodenum. With the development of certain diseases, bile can enter the stomach cavity, and this causes unpleasant symptoms: belching, heartburn, pain in the abdomen, yellow plaque in the language. Not to be overlooked this pathology, because it can cause the development of gastritis, ulcers or even oncology. How to treat bile in the stomach, consider in more detail.

Medicines

If heartburn occurs rarely, as such specific treatment are not assigned. In this case, it is only necessary to comply proper diet nutrition and complete rejection bad habits. If the reflux of bile into the stomach occurs on an ongoing basis and occurs against the background of developing disease in this area, prescribe appropriate therapy. In this case, all measures are taken to eliminate the underlying pathology, normalize the outflow of bile and relieve unpleasant symptoms.

In the treatment of diseases that are accompanied by reflux of bile into the stomach, medications are used that help relax smooth muscles, restore pressure in the bladder, change the structure of the bile fluid, and improve bladder motility. Also, the drugs used are aimed at making bile less toxic to the gastric mucosa.

Besides, in without fail appoint special diet, which will not only help to cope with such a pathology, but also prevent the reflux of bile into the stomach in the future. If conservative treatment fails, a surgical intervention.

Antispasmodics

Drugs with a myotropic antispasmodic effect also have a choleretic effect.

These include Papaverine and Drotaverine.

A drug such as Paraverin is often prescribed if there is a stagnation of bile fluid in the biliary tract, which has occurred due to spasm of smooth muscles. To prevent development allergic reaction, the drug is not used for individual intolerance to its components. When it occurs, Papaverine is stopped.

In addition, the drug is not prescribed to children under the age of six months, and in some cases up to a year, to the elderly, in order to prevent a significant increase in temperature, which is often observed at this age, as well as to patients who simultaneously suffer from arterial hypotension. You can not use Papaverine if glaucoma develops, acute renal failure.

Drotaverin tablets are one of the most effective means in the treatment of gastrointestinal pathologies

The drug Drotaverin is prescribed for spasms of the gallbladder and pain in this area. Its use is contraindicated in kidney failure severe, the same form of liver failure, as well as cardiac, during lactation, children with individual intolerance to the components of the drug.

proton pump inhibitors

The release of bile into the stomach can be eliminated by taking inhibitors proton pump, which ensure the regulation of the level of hydrochloric acid in the stomach by blocking the functioning of the secreting glands. These include drugs Nexium and Omeprazole.

The medicine Omeprazole is not used in such cases:

if co-administration of Atazanavir or Nelfinavir is required;
with a deficiency in the body of substances such as lactase, sucrase, with their intolerance and hypersensitivity to fructose;
children under the age of 2 years and weighing less than 20 kg, if treatment is required for conditions such as reflux esophagitis, gastroesophageal reflux disease;
children under the age of 4 years, if therapy is required for duodenal ulcer, which has developed due to exposure to the bacterium H. Pylori;
children and adolescents under 18 years of age for therapy with drug capsules (10 mg);
with individual intolerance to omeprazole, its constituent components.

The drug Nexium can not be used for diseases accompanied by reflux into the stomach, in the following cases:

with glucose-galactose malabsorption;
with hereditary fructose intolerance;
while taking Atazanavir or Nelfinavir;
with sucrase-isomaltase deficiency;
children under the age of 12;
children and adolescents aged 12-18 years, if treatment of gastroesophageal reflux disease is required.

Antacids

Such drugs help to neutralize the acidity of the contents of the stomach through a chemical relationship with hydrochloric acid. These include Almagel, which, despite high efficiency, is not used in the treatment of reflux with individual intolerance to its components, pronounced violation kidney function, Alzheimer's disease. Also, the medicine is not prescribed to children under the age of 1 month, during periods of pregnancy and lactation.

To antacids Maalox can be attributed, which is no less effective than Almagel. It is not prescribed for renal failure, hypersensitivity to components, fructose intolerance, children and adolescents under the age of 15, with hypophosphatemia. Use with extreme caution during pregnancy and lactation breast milk, with the development of Alzheimer's disease, in old age.

Hepatoprotectors

Hepatoprotective agents help convert bile into a water-soluble form, while eliminating unpleasant symptoms: bitterness in the mouth, belching, heartburn and nausea. These drugs include Ursofalk, which is not prescribed if there are gallstones in the gallstones, with insufficient functioning, acute diseases inflammation, cirrhosis of the liver.

Also, the drug is not used in the treatment of gastric reflux with a pronounced violation of the functioning of the kidneys or pancreas, during pregnancy and lactation, with individual intolerance to the components of the drug.

The drug Ursofalk is often used in the form of tablets, although there is also a suspension with this name.

Hepatoprotectors include such a remedy as Allochol, which cannot be taken with hypersensitivity of its components, simultaneous development of calculous cholecystitis, obstructive jaundice, acute hepatitis, acute and subacute liver dystrophy, gastric and duodenal ulcers, acute pancreatitis.

Prokinetics

The most commonly prescribed drug is from the group of prokinetics Motilium, which, by its effect on the body, contributes to the regulation of the motor function of the digestive tract. Strengthening their secretion ensures the acceleration of the circulation of the bile fluid.

The drug is contraindicated for use with the development of prolactinoma (pituitary tumor), simultaneous treatment with Ketoconazole, Erythromycin and other inhibitors of the CYP3A4 isoenzyme (Fluconazole, Clarithromycin, Telithromycin, etc.), with gastrointestinal bleeding, children and persons weighing less than 35 kg. Special contraindications include individual intolerance to the components of the drug.

Another prokinetic can be called the drug Cisapride, which is also not prescribed for hypersensitivity to the components, gastric and intestinal bleeding, mechanical intestinal obstruction. The medicine is forbidden to be taken during pregnancy and lactation.

Medications to relieve congestion of bile

It is also possible to cure the pathological reflux of bile into the stomach with the help of drugs that eliminate its stagnation by increasing bladder motility. This may be the drug Pancreazim, which is prohibited for admission to persons with individual intolerance to the components, with the development acute pancreatitis, exacerbation of its chronic form. Often the drug causes the development side symptoms: nausea and vomiting, diarrhea or constipation, pain in the abdomen. In such cases, the medication should be stopped.

Another method of getting rid of gastric reflux is the use of magnesium sulfate, which is administered by injection. Such manipulation is prohibited with individual intolerance to the substance, high level magnesium in the body, hypotension, low heart rate, depression respiratory function, renal failure.

The oral method of administering magnesium sulfate is often used, which is contraindicated in case of intestinal bleeding or intestinal obstruction, inflammation of the appendix, and general dehydration of the body. With extreme caution, the drug is used for concomitant pathologies of the respiratory system, renal failure, inflammatory processes in the gastrointestinal tract, myasthenia gravis.

Nutrition

Treatment of bile reflux into the stomach area is recommended to be carried out in combination with compliance with proper nutrition:

before eating it is necessary to drink a glass of still mineral water, but in no case after it;
it is recommended to eat fractionally, in small portions, but often;
dishes should have a normal temperature, not be hot or excessively cold;
the basis of the diet is boiled food (cereals, vegetables, soups);
fried and fatty foods should be excluded from the diet, as well as smoked meats, fruits and vegetables, which increase gas formation;
pickled food, chocolate, jam, pastries, strong coffee and tea are prohibited.

Compliance with proper nutrition is one of the most effective methods in the treatment of reflux and its prevention. The main goal of the diet is to reduce the load on the gastrointestinal tract and normalize overall health.

Fried and fatty - under a special ban for the period of treatment of pathology

Given that the bile fluid is thrown into the stomach cavity, the main volume useful substances consumed with food is not absorbed. It is for this reason that a person quickly gets tired even after minor physical activity. If he experiences systematic stress and is constantly in nervous tension, it also does not have the best effect on general condition. Therefore, any stressful situations must be excluded.

When surgery is required

Many pathological conditions that are accompanied by regular reflux of bile fluid into the stomach cavity can be corrected by surgical intervention. The only exception is chronic inflammation 12 duodenal ulcer. To get rid of such a pathology, the doctor may prescribe one of the following operations:

laparoscopy, which involves the removal of a tumor or the elimination of other pathologies that are accompanied by reflux, through the implementation of small punctures in anterior section abdomen
laparotomy, which is performed by making a large incision abdominal cavity(transverse or longitudinal).

What kind of technique is suitable for this or that person in order to eliminate gastric reflux of bile - conservative or operative, only a doctor can determine. It is for this reason that, in order to avoid the development negative consequences It is not recommended to self-medicate. It is necessary to trust a specialist in this matter.

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 is 12.5%.

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

Among children, adolescents are most often affected.

In 2/3 of all cases it is secondary disease, which develops against the background of the defeat 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, when they opened the abdominal cavity, they did not find any gallbladder no stones, no inflammation. After that, the disease began to be carefully studied by general practitioners.

However, even in antiquity it was noticed that there is a connection between negative emotions human 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, which are described in the treatises of medicine by doctors of antiquity.

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

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

Anatomy and physiology of the gallbladder

gallbladder- a hollow organ. It is usually located on the right in 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 is from 3 to 5 cm. Its capacity on an empty stomach is from 30 to 80 ml. However, with stagnation of bile, its volume increases.

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

The gallbladder has three parts - the bottom, body and neck (narrow part). The cystic duct leaves the neck, which later joins with the hepatic duct to form the common bile duct. In turn, the common bile duct opens into the cavity of the duodenum (12 PC) in the region of Vater's nipple, which is surrounded by the sphincter (muscular 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 sphincter of Lutkens-Martynov at the neck of the gallbladder, which prevents the release of bile before certain stages of digestion.

Muscular layer, which mainly consists of smooth muscle fibers arranged in a circular (circular)

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

Secretion of bile into the lumen of the duodenum as needed

Bile is produced by liver cells continuously (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.

Mechanism of excretion of bile from the gallbladder

The most important neurohumoral factors regulating this complex process are:

The autonomic nervous system (sympathetic and parasympathetic divisions), which regulates the work of almost all internal organs
Normal when activated vagus nerve(vagus), which provides sensory and motor innervation to most internal organs, the gallbladder contracts, and the sphincter of Oddi relaxes. In case of violation of coordination in the work of the sympathetic and parasympathetic divisions of the autonomic nervous system this mechanism is broken.
Intestinal hormones (motilin, cholecystokinin-pancreozymin, gastrin, secretin, glucagon) that are produced in the gastrointestinal tract during meals
When exposed to cholecystokinin, usual doses the gallbladder contracts, and the sphincter of Oddi relaxes (in large breaths, gallbladder motility 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 contraction of the gallbladder.
As a result of the close interaction of these factors during meals muscle layer gallbladder contracts 1-2 times, increasing the pressure in it to 200-300 mm of water column. Therefore, the sphincter of Lutkens-Martynov relaxes, and bile enters the cystic duct. Next, bile enters the common bile duct, and then through the sphincter of Oddi - into 12 PCs. When diseases occur, this mechanism is disrupted.

The main functions of bile in digestion

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

Causes of dyskinesia of the gallbladder

Distinguish between primary and secondary dyskinesia of the gallbladder and biliary tract (JVP), depending on the causes that led to the disease.

Also, a theory is currently being considered about a violation 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 beginning of the disease, there are only functional disorders that are not detected by research methods (ultrasound, X-ray). However, as the disease progresses, structural changes in the gallbladder and its ducts.

The most common causes of primary JVP

Secondary dyskinesia of the gallbladder and biliary tract

Occurs against the background of already developed diseases or conditions. Changes are clearly visible with the input methods of research.

The most common causes of secondary JVP

Symptoms of dyskinesia of the gallbladder

Depend on the type of violation of the motor activity of the gallbladder and its ducts.

Types of JVP

Hypotonic (hypomotor) dyskinesia develops with insufficient contractility of the gallbladder and its ducts. It occurs in patients with a predominance of the tone of the sympathetic nervous system (normally dominates during the day), which lowers 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 old.
Hypertensive (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 dominates at night), which enhances the motor function and tone of the gastrointestinal tract, as well as the gallbladder and its ducts. Most often this form of the disease affects adolescents and young people.
Hypotonic-hyperkinetic dyskinesia is a mixed variant of the course of the disease. The patient has symptoms of both hypotonic and hypertonic forms of dyskinesia in varying degrees expressiveness.

Signs of dyskinesia of the gallbladder

Symptom	Manifestations	Development mechanism
Hypotonic dyskinesia
Pain	Constant, long, dull, bursting, aching. It is located in the right hypochondrium, but does not have a clear localization. As a rule, it increases during a meal or immediately after it.	The bottom of the gallbladder is stretched, which is caused by stagnation of bile due to underproduction cholecystokinin in the gastrointestinal tract.
Belching - involuntary release of gas from the stomach into the mouth 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 does more 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 output sphincter decreases - and the 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)	More often occurs after eating and nutritional errors: eating 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 for bacterial and viral infections, helminthiases, the vomiting center is irritated by the products of their vital activity (toxins).
Bitterness in the mouth (most characteristic of the hypotonic variant of dyskinesia)	Mostly in the morning, after eating or exercising.	Motility is disturbed, and the sphincters of the gastrointestinal tract also relax. As a result, anti-peristaltic movements appear (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 fullness of the abdomen at the height of digestion, which is often accompanied by pain. After the passage of gases, the pain subsides.	Digestion is disturbed due to insufficiency of bile. As a result, the processes of putrefaction and fermentation in the lumen of the small intestine are intensified. Therefore, gases are released into in large numbers.
Decreased appetite		Bile stagnates due to poor contractility of the gallbladder. Therefore, it is not sufficiently allocated to the lumen of 12 PCs.
Diarrhea (rare)	It usually occurs shortly after eating.	With bile deficiency, digestion is disturbed: 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 excretion of water, sodium and chlorine. At the same time, their absorption decreases. Therefore, the volume of the food bolus increases, and its progress through the intestines is accelerated.
Constipation (common)	There is no stool for more than 48 hours or there is a systematic insufficient bowel movement.	It occurs due to 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 rises reverse suction water. At the same time, fecal masses decrease in volume, and their density increases. In addition, there is a lack of bile acids (found in bile), which normally have a stimulating effect on the intestinal muscles.
Obesity	Develops with a long course of the disease or is the cause of its occurrence	Due to the insufficiency of bile, the process of digestion and the 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 the fat cells of the subcutaneous fat, as well as on the internal organs, are enhanced.
	Decreased heart rate, decreased blood pressure, redness of the skin of the face, sweating, increased salivation.	The mechanism of development is complex and not fully understood. However, it is believed that there is a low resistance of the heart and blood vessels to stress. Therefore, during it, less oxygen enters the brain, organs and tissues. As a result, the balance between the sympathetic and parasympathetic nervous systems is disturbed, and the internal organs receive the wrong commands to work.
Hypertensive dyskinesia
Pain	The pain is intense, colicky, occurring acutely in the right hypochondrium after stress or emotional tension(most often), inaccuracies in nutrition, physical activity. The pain lasts from 20 to 30 minutes, repeats several times during the day. Often she gives 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 pectoris. In the period between attacks, as a rule, there is a feeling of heaviness in the right hypochondrium.	The pain is associated with a sharp contraction of the gallbladder during increased tone sphincters of Oddi and Lyutkens-Martynov, so bile does not go away.
Decreased appetite	Bile is a stimulant of appetite, intestinal motility and the production of intestinal hormones.	The gallbladder is in a spasmodic state and is excessively reduced. However, at the same time, the sphincters responsible for the timely flow of bile in 12 PCs do not work or relax between meals. Therefore, bile in insufficient or large quantities enters 12 PCs.
Weight loss (common)	The subcutaneous fat layer becomes thinner, decreases muscle mass.	Due to the release of bile between meals, food is poorly broken down. Therefore, proteins, carbohydrates, fats, vitamins and minerals are absorbed in insufficient quantities. In addition, due to reduced appetite, patients do not eat enough.
Nausea and vomiting	Often accompanied by an attack of biliary colic, and outside the attack, they are usually absent.	Gastrointestinal receptors are irritated due to impaired motility, so nerve impulses are sent from them to the vomiting center (located in the brain). Back from it, impulses are sent to the receptors of the gastrointestinal tract and diaphragm, intercostal muscles, so they contract, spewing gastric contents.
Diarrhea (common)	As a rule, it occurs shortly after a meal 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. stool and speeding up their movement through the intestines.
Symptoms of a violation in the work of the autonomic nervous system (the center is located in the brain)	During an attack, sweating, palpitations, general weakness appear, headache, blood pressure rises. Outside the attack, irritability is noted, fast fatiguability, sleep disturbances, increased blood pressure, the occurrence of aching pain in the heart, palpitations and other symptoms.	The development mechanisms have not been fully established. It is assumed that the basis of the disease is the lability of the nervous system due to the weakness of the heart and blood vessels, which at the time of stress poorly supply organs, tissues and the brain with blood. Therefore, the autonomic nervous system gives the wrong commands to the vessels, the gastrointestinal tract, internal organs as well as the gallbladder and its ducts.
Signs that can develop in both forms of JVP with the same manifestations
jaundice skin and visible mucous membranes (rarely develops)	Appears with a pronounced violation of the outflow of bile (stone, narrowing of the common bile duct). In this case, the feces are colorless, and the urine is colored dark.	With stagnation of bile, 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 an icteric tint. Since bile does not enter the digestive tract, the feces become colorless.
Plaque on the tongue (may develop with other diseases: colitis, gastritis and others)	It may be white or with a yellowish tinge in case of reverse bile reflux (most often occurs with hypotonic variant of dyskinesia). If the plaque is pronounced, then patients may experience a feeling of discomfort on the tongue and a dulling of taste sensations.	It appears as a result of a violation of the processes of keratinization (the transformation of mucosal cells into scales) and desquamation of the epithelium from the surface of the tongue. It occurs due to a violation of the transfer of nutrients to the tongue.

Diagnosis of dyskinesia of the gallbladder and biliary tract

Tasks - determining the type of biliary dyskinesia and identifying concomitant diseases, which 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 the diagnosis of diseases of the gallbladder, as well as the biliary tract.

Cholecystography
It is based on the ingestion of preparations containing iodine (Biliselectan, Cholevid, Yodobil and others).
Indications
- The study of the structure and detection of the presence of stones in the gallbladder
- Study of the excretory and storage (concentration) function of the gallbladder, as well as its extensibility.
Flaw
The impossibility of determining the state of the biliary tract, since they are not visible on the pictures.
Methodology
The patient on the eve of the study at 19.00 takes two raw eggs. Starting from 21.00, accepts contrast agent 30 minutes apart with water. The contrast agent is absorbed in the intestines into the blood, and then excreted by the liver cells.
In the morning on an empty stomach, several overview shots of the right side of the abdomen are taken. Then the patient is offered a choleretic breakfast (as a rule, it is the yolk of an egg) and a series of shots is taken again.
Interpretation of results
In the hypertonic form, the gallbladder sharply and rapidly decreases 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, not emptying due to the fact that there is a 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 the intravenous administration of a contrast agent containing iodine, which accumulates in the gallbladder and its ducts.
Indications
Determination of the tone of the sphincter of Oddi.
Methodology
The patient in the morning on an empty stomach in the X-ray room on the table is intravenously injected with Bilignost solution for 15-20 minutes. And at the same time, a morphine solution is injected to artificially contract the sphincter of Oddi. After 15-20 minutes, a picture is taken, which shows 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 at 15-20 minutes after injection with a width of the common bile duct of 9 mm or more.

Cholangiography
It is carried out to study the bile ducts after the introduction of a contrast agent into them.
Indications
- Suspicion of pronounced narrowing of the bile duct
- Jaundice of the skin and mucous membranes caused by blockage of the bile duct by 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 inserted 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 to the patient, through the mouth and stomach, a probe is inserted into 12 PCs. Then it is laid on the right side and bile is received in portions:

The first phase (“A” portion) is a mixture of pancreatic juice and 12 PCs. It is collected from the moment the probe is inserted until the stimulant is introduced (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 the stimulant (choleretic) is introduced until the next portion of bile appears (the phase of the closed sphincter of Oddi). Normally, the 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. Bile is thick dark brown. Normally, 30 to 50 ml of bile is secreted in 15-25 minutes.
The fifth phase (portion "C") is hepatic, during which light yellow liquid bile is obtained from the intrahepatic bile ducts.

Interpretation of results

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

Worm infestation (for example, giardiasis or opisthorchiasis)
peptic ulcer(using two or three component circuits)
Fighting infection (prescribing antibiotics)
Removal of stones from the gallbladder and treatment of other ailments

Outside the period of exacerbations:

Apply mineral water: with a hypertonic variant - waters of low mineralization (Slavyanovskaya, Narzan, Yessentuki 2 or 4), with hypotonic - waters of high mineralization (Arzani, Essentuki 17).

It is recommended to stay in a sanatorium with a slope for the treatment of diseases digestive system.

Diet for dyskinesia of the gallbladder

Compliance with the diet is the basis for success in the treatment of 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 the normalization of 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 foods
Alcohol, rich broths, seasonings, onion, garlic, radish, sorrel
Confectionery with cream, muffin, chocolate, carbonated drinks, cocoa, black coffee
Foods 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.

Culinary processing:

Products are boiled, baked or steamed: meatballs, steam cutlets etc.

In the first days of an exacerbation, it is recommended to consume foods in liquid mashed or minced form. As it disappears acute symptoms it 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 not 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 lean varieties sausages and sausages
vegetable fats and butter
Honey, sugar, caramel, marmalade, marshmallow
fruit and vegetable juices, as well as fruits and berries of non-acidic varieties (apples, apricots and others)
Tea, coffee with milk
Any cereals and pasta
Soups with vegetable broth

Features of the diet for hypermotor dyskinesia

It is allowed to use the same products 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

Alternative methods of treatment of dyskinesia

A good addition to the main treatment with medicines, 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 flowers into an enamel bowl, 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 the contraction of the gallbladder and improves the outflow of bile Normalizes the composition of bile Improves the work of the digestive tract Locally disinfects
Infusion from corn silk	1 tsp crushed raw materials, pour a glass of boiling water and let it brew for 30 minutes. Then express and take 3 tbsp. l. three times a day for half an hour before meals. Course - 2-3 weeks.	Liquefies bile and eliminates its stagnation Lower blood bilirubin and cholesterol levels
Oregano herb infusion	Pour 2 tbsp. crushed raw materials 200 ml of boiling water. Express after 20-30 minutes. Take the entire infusion throughout the day in three doses 30 minutes before meals. Course - 1 month or more.	Enhances the motor activity of the intestines and biliary tract Has a 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 steep for 30 minutes, then strain. 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
Decoction of licorice root	2 tsp crushed raw materials, pour 200 ml of boiling water, place in a water bath for 20 minutes. Let cool, then strain 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
Decoction or tea from chamomile flowers	1 tsp dry chamomile flowers pour 200 ml of boiling water. Express after 3-5 minutes. Consume for a long time three times a day, like tea.	Reduces bloating Improves the work of the digestive tract Helps reduce or eliminate belching Normalizes the functioning of the nervous system, helps fight insomnia Accelerates the healing of wounds on the mucous membranes (ulcers, erosions) Fights locally with pathogenic microbes Increases appetite

Antacids - are prescribed for diseases of the gastrointestinal tract associated with aggressive exposure acid environment on the mucous membrane of the digestive system. The mechanism of action of drugs is that the main active substance envelops the walls of the stomach, thereby reducing negative impact enzymes and bile. Antacids include: Maalox, Phosphalugel, Rennie, etc. Antacids should be taken regularly after meals.
Inhibitors - reduce the level of acidity of gastric juice and bile. According to the results of exposure, they are similar to antacids. It is not recommended to use these drugs together. The advantage of inhibitors is that they have a longer duration of action than antacids. Most often, gastroenterologists prescribe the following inhibitors: Esomeprazole, Nolpaza, Pantap, Ezocar, Rabeprazole, etc.
Ursodeoxycholic acid - promotes the dissolution of cholesterol gallstones and changes the state of the enzyme medium, reducing its viscosity. Preparations containing ursodeoxycholic acid: Ursofalk, Ursoliv, Ursosan, Urdox, Ursodez, etc.
Selective prokinetics - the mechanism of action of drugs is based on the promotion of food boluses through the gastrointestinal tract, due to which it is digested faster. Selective prokinetics: Motilium, Cerucal, Itomed, etc.

In order to prevent the causes of the release of bile into the intestines, without taking medication, the following preventive measures must be observed:

Diet;
Quit smoking and other bad habits (drinking alcohol, caffeine, etc.);
Refusal of tight clothing, pressing on the abdomen.

In cases where the release into the intestine is an isolated case or occurred due to a violation of the diet, treatment can be carried out at home. If the release of bile or bilious diarrhea is repeated more than once, you should seek help from a specialist.

As measures to eliminate the release of bile, you can apply the following simple methods of treatment:

You can eliminate acid and cleanse the digestive organs by drinking boiled water on an empty stomach. warm water;
Include the following foods in your diet: jelly, dairy products, oatmeal. Such measures will contribute to the enveloping of the gastric mucosa and, as a result, bile will not enter the intestines;
Excessive physical activity should be avoided;
Reception "Smecta" or other sorbent 1-2 times a day. Thus, after three days, the symptoms of the disease must pass. Otherwise, seek the help of a gastroenterologist.

Much easier to stick to simple rules to help you avoid a series of serious illnesses, which are the result of the release of bile into the intestines and stomach, as well as other digestive organs.

Even in the presence of the first symptoms of the disease, appropriate measures should be taken so that the release of bile from the stomach does not penetrate into other digestive organs. When the release occurs only in the stomach, it is enough to stick to a diet and keep healthy lifestyle life, in order to without taking medicines prevent the development of the disease. If the release began to occur in the intestines, then it is necessary to immediately seek advice from a gastroenterologist to prescribe medications that will block and eliminate the further development of the disease.

Bile in the stomach is mainly due to a disease such as gastroduodenal reflux.

AT normal condition bile from the liver moves into the duodenum, then into the intestines, and reverse direction movements are limited by sphincters - circular muscles.

With the development of the disease, bile contents enter the stomach cavity, which leads to numerous unpleasant symptoms.

It is important to know why this disease what to do and how to remove bile from the stomach.

Causes and symptoms of the disease

Before starting treatment unpleasant symptoms it is necessary to understand why this violation appeared.

Doctors identify the main causes of bile reflux into the stomach:

various injuries, benign or malignant tumors, hernias of the organs of the gastrointestinal tract, which compress the duodenum 12, as a result of which bile begins to move into reverse side, overcoming sphincter resistance;
pregnancy provokes casting due to the same mechanism as the cause described above. The fetus begins to compress the intestine, thereby increasing pressure and contributing to the accumulation of bile in the stomach;
the presence of chronic duodenitis, which is swelling and inflammation of the duodenal mucosa. The pressure increases and bile is thrown into the stomach;
carrying out an operation during which the fibers of the sphincter muscles were dissected;
use medications over a long period, especially drugs that relieve spasms, and muscle relaxants - drugs that reduce muscle tone;
congenital features of anatomy.

The reasons why bile enters the stomach cavity may be completely unrelated to disorders in the digestive system.

Factors due to which bile is thrown into the stomach:

regular overeating;
the constant presence in the menu of too fatty, spicy, salty and smoked foods or the use of poor-quality foods;
frequent eating before bed;
drinking liquids with meals, especially soda or alcohol
active physical activity immediately after eating can promote bile in the stomach.

To begin to treat the disease should be with the elimination of the causes that led to this. Sometimes the reflux of bile into the stomach can occur in quite healthy people. If such a violation is of a one-time nature, then the symptoms do not appear.

However, with the development of gastroduodenal reflux in most cases, the following clinical symptoms can be observed:

constant or intermittent pain, which in fact accompanies any disease of the digestive system. The release of bile into the stomach occurs without a specific location of pain;
belching with bad smell and bitter aftertaste;
heartburn occurs when there is a lot of bile in the stomach that enters the esophagus. Burning begins regardless of food intake;
feeling of fullness in the abdomen;
a yellow coating forms on the mucous membrane of the tongue;
nausea and vomiting with bile. With excessive vomiting, symptoms of dehydration appear.

Bile in the stomach can lead to inflammation of the mucous membrane of the organ due to the aggressive effects of acids.

If a timely treatment is absent, then in most cases the patient develops symptoms of gastritis or ulcerative damage.

The release of bile into the stomach and then into the esophagus is very dangerous, since this can lead to cell metaplasia.

Diagnosis and treatment

Treatment of reflux of bile will be more successful if it is diagnosed early, so when the first signs appear, you should consult a doctor and know what to do for treatment at home.

The most effective diagnostic methods are the analysis of the patient's history and instrumental examination of the organs of the gastrointestinal tract.

The following studies are used:

laboratory analysis of functional liver tests;
ultrasonography using an endoscope is used to determine the size of stones in bile ducts subject to availability;
duodenal sounding;
magnetic resonance cholangiography can detect gallstones even at the initial stage of education;
cholescintigraphy helps to determine the tone of the gallbladder using a visual examination;
ultrasonography is necessary to rule out cholelithiasis and determining the size of the gallbladder;
choledochoscintigraphy helps in identifying disorders of the sphincter of Oddi;
a special test is also carried out to determine the patient's readiness for surgery.

Treatment of a disease such as reflux of bile into the stomach is aimed at normalizing the movement of bile and secretory function pancreas, as well as to increase the tone of the sphincter muscles.

Treatment includes the use of myotropic antispasmodic drugs with a choleretic effect, non-selective blockers, which have a relaxing effect on smooth muscles, proton pump inhibitors, which should neutralize excessive amounts of hydrochloric acid, choleretic drugs to improve gallbladder motility.

Also, the doctor always supplements the treatment with Ursofalk, which makes bile acids more water-soluble, so they become less aggressive to the gastric mucosa.

You should definitely supplement the treatment of excess bile with a diet. It will help to alleviate the course of the disease and eliminate unpleasant symptoms.

To successfully treat bile reflux, completely eliminate salty, fatty, spicy and smoked foods, as well as alcoholic beverages and sweet soda, from the diet.

Folk recipes

The reflux of bile into the stomach can be treated not only in a medical way but also folk remedies. Some recipes are quite effective in eliminating symptoms at any stage of the disease.

You can treat the disease with such folk remedies:

pour a liter of boiling water 2 tbsp. l. collection of barberry root, chicory herb and dandelion rhizome, taken in equal parts. Insist overnight and take the next day half a glass before meals in a warm form;
to get rid of the symptoms, you should pour 1 liter of boiling water with a collection of thyme, St. John's wort, plantain and immortelle (1 spoon each), boil for 1 minute, and then cool and drink the whole day in a small volume;
pour a liter of water marshmallow root, plantain, caraway seeds and oregano, then bring to a boil over low heat. To get rid of bile, drink a decoction 30 minutes before meals, 1 tbsp. l.

Before self-adoption any folk recipes and medications, be sure to consult your doctor.

There are several pathologies in which bile enters directly into the stomach. In this case we are talking about inflammatory processes in the gallbladder and liver, hepatitis and cholecystitis. If the release of bile into the stomach occurs no more than once a month, then patients should not worry. In the case when this phenomenon occurs systematically, and at the same time a person experiences a strong pain syndrome, then you should immediately contact a gastroenterologist.

The release of bile into the stomach can occur for the following reasons:

a person does not have a gallbladder;
in the 12th duodenum, the pressure has risen strongly;
there was a weakening of the sphincter, which connects the duodenum with the stomach;
postoperative period (during surgical intervention muscles were affected)
mechanical damage to the abdomen, as a result of which the work of the muscles in the gastrointestinal tract was disrupted;
recovery process after gallbladder removal;
pregnancy, against the background of which compression of the digestive tract occurs;
oncological processes;
hernia;
duodenitis (chronic stage);
the production of protective mucus occurs in insufficient quantities;
the habit of sleeping on the left side, especially on a full stomach;
impact medical preparations, especially antispasmodics, etc.

People might suspect it pathological condition may according to the following:

There is a bitter taste in the mouth. As a rule, this condition is caused by the lack of food in the stomach.
Fetid eructation, after which bitterness remains in the mouth. The bile that enters the stomach reacts with the digestive juices. As a result of this interaction, the amount of gases, the release of which is difficult to control, increases.
A dense yellowish coating appears on the root of the tongue.
Vomiting reflex. When examining vomit, bile impurities can be detected.
Heartburn. With pathological processes in the stomach, the amount of protective mucus decreases, as a result of which this unpleasant process occurs.
Pain syndrome, the localization of which is the epigastric zone. Pain can be both weak and intense.
In advanced cases, symptoms of gastritis or ulcerative pathology appear.

If people have identified anxiety symptoms in themselves, then they do not need to engage in amateur activities that can lead to grave consequences. In this case, the best solution would be to visit medical institution for a consultation.

The gastroenterologist, before making a final diagnosis, will prescribe a complex of laboratory and hardware studies to the patient:

ultrasound. Thanks to this diagnostic method, specialists are able to identify cysts, stones, and other neoplasms in the digestive tract.
Radiography before which the patient should drink a contrast agent. Through this diagnostic procedure specialists evaluate the condition of the organs, their functionality, location, etc.
FGDS. When carrying out this diagnostic procedure, specialists through the inserted camera identify any defects. Also, if necessary, they take material, gastric juice, bile.

After the diagnosis and establishment of the causes of the development of such a pathological process, the gastroenterologist develops drug regimen, which will neutralize the bile present in the stomach.

The specialist sets himself the following tasks:

stop the pathological process;
remove excess acid;
eliminate backfire that arose against the background of irritation of the mucous membrane;
prevent possible complications.

To remove bile that has accumulated in the stomach, a gastroenterologist can make the following appointments:

The patient must adjust his lifestyle.
A therapeutic diet is prescribed.
Medicines are prescribed.
Steps are being taken to alleviate symptoms.
The reasons for the development of such a pathological process are eliminated. If it was caused by the pathogenic bacterium Helicobacter, then the disease will have to be treated with antibiotics. Anti-inflammatory drugs, choleretic agents may also be prescribed.
If indicated, surgical intervention is performed.

To reduce the amount and frequency of bile thrown into the stomach, the following drugs may be prescribed:

Inhibitors (proton). Medicines, which are included in this group, affect the secretory glands, so that their components manage to regulate the level of acid. Nexium, Omeprazole, etc. are prescribed.
A group of antacids, which includes Almagel, Maalox. Their action is aimed at neutralizing acidity.
At pain syndrome antispasmodics are prescribed, for example, No-shpa.
Prokinetics like Motillium. The drug regulates the motor function of the gastrointestinal tract. Due to its effect, the contractility of the organ is increased, and bile begins to circulate much faster.
Medicines, the action of which is aimed at eliminating stagnation of bile, increasing bladder motility. For example, Cholecystokinin, Magnesium Sulfate.
To stop the accompanying symptoms and convert bile into a new form (water-soluble), gastroenterologists prescribe Ursofalk.

Troubleshooting the problem promptly

Many pathological processes in the gastrointestinal tract, accompanied by the release of bile into the stomach, require surgical treatment.

Currently, modern medicine has stepped far ahead, so surgical interventions are carried out in less traumatic ways:

Minimally invasive surgery - laparoscopy. The specialist makes several small punctures in the abdominal cavity. Through these holes, a special tool is inserted inside, and a probe equipped with micro-optics. Patients tolerate this type of surgery very well. The rehabilitation process is reduced to a week, while after abdominal surgery patients are forced to experience for several weeks severe pain. Virtually eliminates the risk of postoperative complications.
In the absence of a minimally invasive operation, patients undergo a classical laparotomy. This type of surgery allows you to remove diseased organs. Patients may face various difficulties in the postoperative period. They also increase the risk of complications. The rehabilitation process involves the constant processing of sutures, taking medications, and undergoing physiotherapy procedures.

Systematic release of bile into the stomach can cause serious complications:

reflux gastritis may develop;
gastroesophageal pathology (reflux) may develop;
Barrett's disease (precedes malignant processes) may develop.