throwing up bile

Throwing up bile is not always a cause for concern, since it may result from less serious conditions, such as vomiting on an empty stomach.

Bile is a greenish-yellow fluid produced by the liver that is stored in the gallbladder. It is essential for digestion and breaking down fats into smaller fractions called fatty acids, which can be absorbed easily by the digestive tract.

Bile contains bile acids (also called bile salts), cholesterol, bilirubin, water, enzymes and small traces of metals. Slightly alkaline in nature, bile is released into the duodenum, the upper fragment of the small intestine.

Bile vomiting isn't always a sign of serious illness. Vomiting green or yellow bile on an empty stomach is common, as the body has nothing else to release besides digestive secretions. Furthermore, vomiting is a natural mechanism of the body to get rid of toxins or can also be caused by infections of the digestive tract or drugs.

However, vomiting bile or vomiting, in general, could indicate a major health problem, such as appendicitis. If vomiting persists or causes discomfort that suddenly escalates and spreads over the abdomen, it is possible that the appendix has burst, and one should seek medical help right away.

What are the causes of bile throw up?

Bile can be vomited up as a sign of health problems, such as bile reflux (bile moves back from the liver into the stomach).

Other factors of throwing up bile may include:

  • Food poisoning
    • Food that is prepared in unhygienic conditions has a higher chance of contamination with microorganisms, such as bacteria and viruses.
    • Intake of contaminated food or water causes food poisoning and symptoms include vomiting, diarrhea, abdominal pain and fever.
  • Gastroenteritis
    • Gastroenteritis is also called infectious diarrhea or stomach flu.
    • It is caused by contaminated food or water, and it is similar to food poisoning.
    • It is the inflammation of the gastrointestinal tract, making it difficult to digest the food.
    • As a result, the patient ends up vomiting bile along with food particles and suffers from diarrhea and abdominal pain, which may lead to dehydration.
  • Food allergies
    • Some patients may be allergic to certain foods, which can trigger severe reactions, such as vomiting, abdominal pain, breathlessness and skin rashes.
    • Intestinal blockage
    • Intestinal block or twisting of the gut prevents the food from moving in the intestines.
    • This results in vomiting of the food along with bile.
  • Gallbladder inflammation
    • The gallbladder is a small organ.
    • Inflammation of the gallbladder or removal of the gallbladder may cause vomiting of bile.
  • Cyclical vomiting syndrome (CVS)
    • CVS causes recurrent episodes of severe vomiting and nausea.
    • However, there is no specific reason for this condition.
    • It is observed that vomiting bouts seem to occur at the same time every day, are of the same strength and last for the same amount of time.
    • It is thought that CVS may be triggered by a variety of factors, such as infections, stress, excitement and menstruation.
  • Dehydration
  • Pyloric valve malfunction
    • A pyloric valve or sphincter is a strong muscle located between the stomach and duodenum.
    • This controls the passage of food from the stomach to the duodenum and regulates the release of bile.
    • This valve may malfunction, leading to vomiting of bile.
    • This condition is commonly seen in older people.
  • Alcohol intolerance
    • People who are intolerant to alcohol tend to vomit after drinking because the body wants to get rid of toxins.
    • Bile is also expelled out along with alcohol.
    • Vomiting bile in the morning is considered worse than vomiting bile at night because it may cause vomiting bile hangover.
  • Pediatric causes of bilious vomiting
    • Developmental abnormalities, such as duodenal, jejunoileal and colonic atresia (insufficient development of gut), meconium ileus and meconium plug (that happen in case of complications during birth), Hirschsprung disease (absence of nerve plexus that controls rhythmic gut movements) and necrotizing enterocolitis (gut infection), are serious causes of biliary vomiting that require immediate medical attention.
    • Bariatric surgeries, such as gastric bypass or total or partial stomach removal, may also cause bile reflux and bilious vomit.

When bile is vomited, stomach acid is also expelled, which can combine with the bile to cause heartburn. To avoid dehydration, drink plenty of water and replace lost electrolytes by drinking Gatorade, coconut water or fruit juices.

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What are the treatment regimen and preventive measures for vomiting bile?

Certain remedies can prevent the intensity and frequency of bile vomiting, such as:

  • Small multiple meals
    • Eating small meals at multiple intervals decreases the pressure on the digestive system.
    • Therefore, the pyloric valve does not malfunction, which is usually seen with larger meals.
  • Sitting upright post meals
    • It is recommended to sit upright for two to three hours post meals.
    • This promotes better digestion.
  • Avoid problematic food
    • Avoid foods that cause allergy or acid reflux, including caffeine and spicy foods.
    • Decrease fat food intake because it decreases the need to produce bile.
  • Weight loss
    • Obese people are believed to exert unnecessary strain on the stomach and internal organs.
    • Therefore, losing weight may reduce such undue pressure and help reduce acid reflux.
  • Avoid smoking and alcohol
    • Smoking irritates the trachea because mucus membranes get dry and produce less saliva, which may increase the chance of bile vomiting.
    • Alcohol irritates the esophagus and relaxes the esophageal sphincter, which causes reflux and vomiting of bile. Vomiting is also caused by alcohol intolerance. Vomiting bile after alcohol consumption is also very common.

In most cases, the bile reflux may subside within a few weeks with changes in the diet. The BRAT diet, which includes banana, rice, apple sauce, dry toast and soda crackers, is believed to give temporary relief. However, some patients with severe symptoms may require medical management or surgery.

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Medically Reviewed on 8/23/2021
References
Cohen L. Bilious Vomiting in the Newborn. Adv Pediatr Res. 2018; 5:13. https://www.longdom.org/articles/bilious-vomiting-in-the-newborn.pdf

Gotfried J. Nausea and Vomiting in Adults. Merck Manuals. https://www.merckmanuals.com/home/digestive-disorders/symptoms-of-digestive-disorders/nausea-and-vomiting-in-adults