Bile reflux gastritis is not a the result of the cholecystectomy but may be seen in a subset of patient with other confounding conditions. Bile is produced in the liver and stored in the gallbladder. In response to high fat and protein in the stomach, the gallbladder contracts to ” squeeze” the bile stored in the gallbladder into the small bowel to help absorb the fat and protein.

With the gallbladder removed, the bile produced by the liver cannot be stored and goes directly to the small bowel via the biliary tree.

It is possible and likely that some of the bile will find its way back to the stomach. In some patients, due to compounding circumstances, the bile may collect and cause gastritis. We need to dissect this a little for it to make sense.

• Not every patient after cholecystectomy will have bile in their stomach.
• Not every patient with bile in the stomach has gastritis.

To appreciate this, let’s remember that for bile to get from the small bowel to the stomach, it needs to:

• Go upstream, against the peristalsis of the small bowel, and do not be washed down by the flow of the gastric
• juices coming out of the stomach.
• Go through the pyloric valve.
• If it reaches the stomach, the acid in the stomach does not neutralize it, causing gastritis.

As I’m sure we all appreciate, other contributing factors besides cholecystectomy may cause bile reflux and bile reflux gastritis. This is why it’s also emphasized that bile in the stomach alone does not confirm biliary reflux gastritis. It is also why we always state that bile reflux gastritis is a disease of exclusion, where other conditions such as gastroparesis, acid reflux, and hiatal hernia (regardless of size, as some patients are unfortunately told that since the hernia is small it does not need to be fixed, which is incorrect) must be considered. Further information on Bile Reflux.  

Billary Diversion is the only definitive surgical procedure for Bile Reflux Gastritis.