Vomiting bile (a yellow or greenish fluid) is a very unpleasant and sometimes painful symptom. This occurs in most patients due to mild causes, such as a stomach flu, excessive alcohol consumption or food poisoning. However, some more serious causes of bile vomiting are also known that even require urgent medical attention. Most causes of bilious vomiting have a clear cause, but sometimes it is difficult for the doctor to identify the cause and thorough investigation is required.

• What is bile?
• Mild causes of bile vomiting

• Stomach flu
• Alcohol abuse
• Yellow colored food
• Respiratory tract infections
• Food poisoning

• Serious causes of bile vomiting

• Cyclic vomiting syndrome
• Intestinal obstruction (blockage of intestine)
• Bile reflux

• Alarm signals
• Prognosis: Depending on underlying cause
• Prevention of bile vomiting

What is bile?

Bile is the greenish-yellow fluid made by the liver and stored in the gallbladder. Bile aids food digestion by primarily breaking down fats and converting them into fatty acids. Bile is composed of certain metals, bilirubin, cholesterol, bile acids, water and salts.

Mild causes of bile vomiting

Stomach flu

When a patient vomits bile, it may be due to gastroenteritis (stomach flu). This involves vomiting all the food from the stomach and the patient then vomits bile.Vomiting bile sometimes happens due to alcohol abuse / Source: Jarmoluk, Pixabay

Alcohol abuse

A patient who drinks excessively may later vomit bile. This type of binge drinking is easily treated with rest and adequate fluid intake with electrolytes. Severe symptoms require hospitalization.

Yellow colored food

Ingestion of an excessive amount of yellow-colored food may cause the vomit to turn yellow when vomiting. Common foods that cause this include corn and carrots. This is not a serious problem and does not require medical treatment.

Respiratory tract infections

Respiratory tract infections (colds, flu) sometimes lead to vomiting of yellow bile. This is caused by the infection producing large amounts of mucus. This mucus contains bacteria and other infectious microbes that pass through the throat and infect the stomach. This fluid constantly accumulates in the digestive system, causing the patient to feel nauseous. This causes him to vomit the mucous-rich yellow bile. By treating the respiratory infection, the vomiting yellow bile disappears.

Food poisoning

Patients with food poisoning sometimes also experience vomiting bile. Just as with alcohol abuse, rest and sufficient fluids are necessary, but if this is not effective, hospitalization will follow. The patient receives intravenous (via a vein) fluid administration to treat the symptoms and prevent further complications (such as dehydration).

Serious causes of bile vomiting

Cyclic vomiting syndrome

Cyclic vomiting syndrome, a rare condition, causes a patient to gag and vomit without cause. After vomiting, he no longer experiences any symptoms. Antiemetics (medicines for nausea and vomiting) and antidepressants are commonly prescribed medications for the disease.

Intestinal obstruction (blockage of intestine)

An intestinal obstruction is a common cause of bile vomiting.Various underlying causes may be the basis of an intestinal blockage, such as:

• other cancer tumors
• colon cancer
• diverticulitis or an infection in the digestive tract
• a hernia
• an intussusception
• fecal impaction (stuck dry and hard lump of stool)
• gallstones (hard deposits in gallbladder with biliary colic)
• irritable bowel syndrome (disease with symptoms of diarrhea and constipation)
• ileus (stopped bowel movements with blockage of intestines)
• adhesions and scar tissue due to surgery
• volvulus (intestinal knot: twisting in the intestine)

Intussusception In children under three years of age, intussusception is the most common cause of intestinal obstruction. With intussusception, a higher part of the intestine slides into a lower part, similar to the withdrawal of a telescope. The condition causes pain that comes and goes at first and then becomes constant. The patient has a pale appearance (pallor), is tired, weak and is vomiting.A patient who vomits bile and suffers from intestinal blockage experiences one of the following symptoms:

• episodes of abdominal pain and cramps
• constipation
• a loss of appetite
• a swelling of the abdomen
• no flatulence

Diagnosis is made through a physical examination and additional tests such as an ultrasound, a CT scan, air or barium enemas (X-ray of the colon and rectum) and/or X-rays. This serious condition requires immediate medical attention to prevent complications such as sepsis (blood poisoning), tissue death and malnutrition. Surgery to repair an intestinal obstruction is necessary. A surgeon removes part of the intestine or the source of the blockage during the procedure. The doctor also sometimes places a stent to open a blockage and prevent further obstructions. The doctor also treats the underlying problem. For example, if the patient suffers from colon cancer, the doctor will determine the cancer stage to see whether metastases are already present. The treatment usually consists of (a combination of) chemotherapy, surgery, radiation (radiotherapy) and/or other targeted therapies.

Bile reflux

Bile reflux is not the same as acid reflux, although the symptoms are similar. The condition occurs when bile flows back into the patient’s stomach and esophagus. Bile reflux usually occurs after surgery (such as gastric bypass or gallbladder removal), or due to stomach ulcers. If a patient vomits bile due to bile reflux, one or more of the following signs also occur:

• a sour taste in the mouth
• severe upper abdominal pain
• weight loss
• coughing or hoarseness in the throat
• nausea
• often heartburn

The doctor usually suspects that the patient is suffering from bile reflux based on the description of the symptoms. However, further investigations are often necessary to confirm the diagnosis because the symptoms are also reminiscent of astrooesophageal reflux. Proper diagnosis is crucial for treating bile reflux because all treatments for acid reflux do not work for bile reflux. The doctor prescribes medications to treat bile reflux. Two common types of medications that control symptoms are bile acid sequestrants and ursodeoxycholic acid. If the medications are not or insufficiently effective, surgical treatment is required, such as gastric bypass surgery. The doctor makes a new opening for the small intestine that prevents a build-up of bile in the stomach.Patients who vomit bile and experience chest pain should visit a doctor / Source: Pexels, Pixabay

Alarm signals

Bile vomiting may not require medical attention if it has an obvious cause and is resolved with conservative methods, such as rest and adequate fluid intake. Unexplained or persistent vomiting requires medical advice to obtain a correct diagnosis and avoid complications. Urgent medical attention is also required if there are signs of bile reflux or dehydration. If one or more of the following symptoms occur in combination with vomiting bile, a visit to the doctor is necessary:

• blood in the stool or mucus in the stool
• diarrhea
• a protrusion or lump in the abdomen
• severe abdominal pain
• complaining or crying in pain
• coffee grounds vomit
• fever
• difficulty breathing
• unexplained weight loss
• inability to stop vomiting
• chestpain
• dehydration
• fatigue

Prognosis: Depending on underlying cause

The causes of vomiting bile determines the prognosis. Most patients recover from acute problems, such as after a night of drinking or food poisoning. When patients suffer from an underlying medical condition, they may also recover, but treatment depends on the condition. For example, an intestinal obstruction, if left untreated, quickly leads to sepsis or an abscess, which are life-threatening complications. For colorectal cancer, the prognosis depends on the cancer stage and the effectiveness of the treatment.

Prevention of bile vomiting

It is not always possible to prevent the cause of bile vomiting. However, lifestyle changes prevent the most common causes. People therefore do not drink too much alcohol, they stop smoking and they also opt for a healthy and balanced diet full of fiber, vegetables and fruit. Furthermore, it is not wise to lift heavy objects because this increases the risk of a hernia. Finally, a regular colonoscopy is wise if the doctor recommends it.

read more

• Bile reflux: Backflow of bile into the stomach and esophagus
• Cyclic vomiting syndrome: Vomiting without cause
• Vomiting (vomiting): Causes, treatment and prevention
• Nausea: Causes and treatment of feeling nauseous