Hi all, 

I was diagnosed with acute moderate gastritis due to infection (h. pylori picked up on a trip to a developing country) as well as bile reflux gastritis upon endoscopy about a month ago.

Wondering if anyone has tips for dealing with bile reflux gastritis or if anyone developed it after a GI infection, rather than gastro surgery. It doesn't seem like there is much literature out there on bile reflux, particularly for patients without typical risk factors (like me), and prognosis isn't encouraging -- improvement with medication or lifestyle changes is hit or miss from what I've read. Most of the literature seems to focus on acid reflux, too, which is a whole separate ballgame, as treatments for acid reflux are of limited efficacy for bile reflux. Plus, bile is apparently particularly damaging if it gets places where it's not supposed to be...I would really appreciate some ideas on bile reduction, as I'd prefer to keep all of my digestive organs as intact, uninflammed, and cancer-free as possible.

Where I'm at now: 

Been absolutely miserable, debilitated even, and unable to work for two months (I normally never miss a day as I love my job). I've lost 10 lbs, which is more than 10% of my body weight due to illness. Never had stomach problems previously and onset of symptoms coincide with my most recent trip -- rapid escalation in symptoms were noted 3 weeks after return. Severe, gnawing abdominal pain that penetrates through to my back, stomach and intestinal cramping with gurgling (I can have a full conversation with my stomach sometimes), hours-long periods of dry heaving, and near constant nausea or at least extremely sour taste in my mouth. If dry heaving is more controlled, I have almost constant burning and indigestion -- feels like I'm a fire breathing dragon! Even having popsicles or water can make me burp (could never do so before) as can changing head position. Motion sickness greatly exacerbates nausea. Symptoms prompted three ER trips prior to endoscopy, and I really hate ERs. 

Reflux has been so bad that my tongue is constantly yellow-green from bile and my voice is hoarse, despite avoiding meals before bed and using a wedge pillow to keep me elevated. Before the wedge pillow, I would wake up with a wheezy cough, most likely from aspirating. Doctor has kept on clindamycin in case aspiration is on verge of turning into bacterial infection. Been having some mood and concentration issues, some of which are listed side effects of the antibiotics, others I think are due to GI and nutritional imbalances. Have some dizziness for an added twist as well.

Current treatment: 

I've completed the standard treatment course for h. pylori with limited improvement (PPI, Flagyl, tetracycline for two weeks) and am on a bunch of other meds:

Carafate for last two weeks with only minimal, short-term relief right after taken;

Ursodiol, started two days ago to see if that will help -- could take some time to see improvement;

Clindamycin for last three weeks due to recurring temperature of 100.1-100.4 in afternoons; 

Nexium 20mg 2xday (PPI);

Zofran for nausea;

Bentyl for stomach cramps and dry heaving; and

a high-quality probiotic.

Occasional Pepto and antacids when extremely symptomatic, but can't take within two hours of antibiotics or carafate so that's a bit challenging -- they also don't really work. Had been on Flagyl for two weeks prior to h. pylori diagnosis as a stop gap measure.

In terms of diet, I've been on a clear liquids and BRAT with high-calorie Boost drinks for two months with little improvement. I cut out dairy and most fats, except for good fats like avocados and fish proteins, when I can tolerate the thought of meat. Cashew-almond milk is the one liquid that seems to be soothing. All acidic fruits and fruit juices are out. 

Previous tests and risk factors:

Tested for other infections, including parasites multiple times, all negative. I do not have celiacs. Had a HIDA scan (normal, with gallbladder function above 95%, but bile reflux into stomach noted) and gastric emptying exam (normal too), so gallbladder issues and gastroparesis may be less likely culprits. Also been checked for pancreatitis (normal on imaging, lipase normal too).

I don't have any of the traditional risk factors for bile reflux. I've never had gastric surgery, I'm young, I'm not overweight (if anything I'm slightly underweight with a pre-illness BMI of 17.6), I don't drink excessively (max 1 glass of wine per week prior to illness), I don't smoke, I don't eat fatty foods, and I've always been a grazer -- preferring small meals. I have some stress in my life, but it shouldn't be the sole cause of bile reflux.

The overarching theme in literature is that bile reflux is caused by pyloric sphincter weakness, which allows bile to backwash from the small intestine into the stomach. Typically this occurrs if there's damage (like during surgery) or evidence of gastroparesis, gallbladder dysfunction, ulceration near the pyloric valve, or inflammation of the pyloric valve. With normal HIDA and gastric emptying scans, gallbladder and gastroparesis are less likely. Ulceration and visible inflammation near the pyloric valve wasn't noted on endoscopy and duodenum was normal. 

I'm thinking infection-related inflammation of the gallbladder or pyloric valve that wasn't necessarily picked up on imaging? Interested in other atypical sources of bile reflux. Had Lyme multiple times (positive ELISA and Western blot), which can apparently damage your gallbladder -- I was treated with IV Rocephen. Been tested multiple times for coinfections (negative) and never had gastro issues with the Lyme.

All thoughts welcome as I'm desperate for relief or at least a timeline for improvement!