Non-Acidic or Alkaline Reflux

While acid reflux refers to a condition where stomach acid comes up from the stomach into the esophagus, another, less-common condition can occur known as alkaline reflux or bile reflux. This occurs when bile produced in the liver flows from the small intestine into the stomach and esophagus. The condition can occur simultaneously with acid reflux or separately.

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Alkaline reflux shares similar symptoms as acid reflux, making the two difficult to distinguish from one another. Commonalities include heartburn, nausea, vomiting and hoarse throat. However, one symptom distinguishes it from acid reflux: burning pain in the upper abdomen. This is because alkaline reflux affects the stomach lining as well as the esophagus. Acid reflux affects typically only the esophagus because the acid is naturally present in the stomach lining. You also may experience unintended weight loss as a side effect because the pain may reduce your appetite.


Your body naturally needs bile to break down fats. The bile is alkaline, or basic, meaning it has a pH ranking greater than 7 on the pH scale. Like acid, a basic substance like bile can burn as well. Bile reflux occurs when the valve that connects the stomach and small intestine opens too widely, allowing the bile to reflux into the stomach. A number of factors can cause alkaline reflux, ranging from a peptic ulcer to complications after gastric surgery, to a symptom that occurs after gallbladder surgery. A physician can diagnose this condition via an endoscopy test, which involves inserting a thin, flexible tube down your throat to view the esophagus. Another test known as the ambulatory acid test can measure the level of acid in your stomach, which can also indicate the presence of alkaline in your stomach.


Treating alkaline reflux is typically more difficult than acid reflux because treatments must reach the small intestine without interfering with the stomach's natural acid/base balance. Physicians will typically begin with conservative measures, such as ursodeoxycholic acid, a treatment that promotes the flow of bile while lessening alkaline reflux pain. Another treatment known as proton pump inhibitors also may help treat the symptoms of both acid and alkaline reflux. If your symptoms do not respond to these treatments, however, your physician may recommend surgery to correct the inoperative valves.


Alkaline reflux seems to be less connected with lifestyle factors than acid reflux -- but that doesn't mean taking steps like losing weight and eating a healthy diet can't help. Sleeping with your bed slightly raised can help to encourage proper acid flow at night. Also, take time to perform stress-relieving activities. This is because stress can affect your digestion. Taking a walk, breathing deeply or reading a favorite book may help to provide symptom relief.

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