Acid reflux, Bile reflux, and Gallbladder Surgery

Hello,

I had my gallbladder removed a few years ago and am having a recurrence of bile reflux symptoms. I’m normal weight, don’t smoke, eat healthy and sleep elevated. PPI’s have no benefit. Is Ursodiol an appropriate medication to try? How often and how much? Thank you!

Dear Kelly,

Gallbladder disease and acid reflux or GERD are two common but different medical problems. 30% of the population in Houston have gallstones and 30% suffer from heartburn. Not all patients with gallstones need to have their gallbladder removed. Similarly, not all patients with heartburn qualify for acid reflux disease. Gallbladder surgery or laparoscopic cholecystectomy is indicated for acute or chronic cholecystitis as well biliary dyskinesia. Acid reflux surgery in the form of Nissen fundoplication with hiatal hernia repair is offered to patients with documented GERD. The diagnosis and staging of GERD are made using a number of tests mainly upper endoscopy and ambulatory esophageal pH testing. Bile reflux typically co-exist with acid reflux. Nissen fundoplication re-establishes the anti-reflux barrier and stop any form of reflux from the stomach into the esophagus. Proton pump inhibitors, PPIs, mask symptoms of acid reflux but do not cure GERD.

There is evidence to suggest that bile reflux increases following gallbladder resection. Furthermore, one study showed that PPIs reduce gallbladder function and possibly increase the incidence of gallbladder stone formation and symptomatic biliary dyskinesia. Consequently, patients with acid reflux disease on chronic PPI treatment are more likely to have their gallbladder removed then the general population. This is my personal observation in my own practice as I have noticed a higher incidence of laparoscopic cholecystectomy in patients presenting for acid reflux management. If you suffer from GERD and you undergo a cholecystectomy, gallbladder resection, your GERD related symptoms may get worse after surgery due to increased bile reflux.

Ursodiol, a naturally occurring bile acid, prevents the formation of cholesterol gallstones. Ursodiol does not stop or decrease bile reflux.

I recommend evaluation by a reflux specialist. If you suffer from GERD, laparoscopic hiatal hernia repair and Nissen fundoplication are recommended. This approach is considered the gold standard treatment for GERD. Nissen fundoplication and hiatal hernia repair when properly performed are safe, effective and durable.

Healthy Regards,

Dr. Darido