What Is the Biliary System?

Medically Reviewed by Melinda Ratini, MS, DO on June 08, 2021
4 min read

Your body’s biliary system encompasses your bile ducts, gallbladder, and the associated digestive structures. This system works together to move bile, also called digestive fluid, through your system as it is needed for digestion.

Bile is a yellow-green fluid that has two functions. The first is to break down fats when food is digested. The second is to carry waste away from your digestive system. Bile contains a salt component that breaks down fat, absorbs it, and moves it through your digestive system and into your feces for removal.‌

Bile begins in your liver, where it is created by special cells. From there, your bile ducts collect the bile and move it through the hepatic duct until it joins the cystic duct from your gallbladder and becomes the common bile duct.‌

Through this process, approximately half of your bile is stored in your gallbladder, which is located just below your liver. When you eat snacks and meals, your gallbladder releases the bile into your intestines to help break down fats.‌

Your gallbladder controls the amount of bile released, which depends on how much your stomach needs for digestion. Your biliary system also serves to drain waste from your liver into the duodenum, a part of your digestive system that is just below your stomach.

A number of problems may affect your biliary system and lead to negative health consequences.

Bile reflux. When your bile backs up into your stomach instead of going down to help with digestion, it’s called reflux. Sometimes the bile enters your esophagus, the tube that connects your mouth and throat to your stomach.

Bile reflux may also include gastric acid from your stomach, although usually the two conditions are different. Gastric reflux frequently turns into gastroesophageal reflux disease (GERD), a chronic problem that irritates your esophageal tissue and leads to inflammation.‌

Gastric acid reflux may be addressed or controlled with changes to your diet or introduction of medication. However, diet changes won’t improve your bile reflux. Instead, you’ll have to try medication or surgery in severe cases of the condition.‌‌

Symptoms of bile reflux include:

  • Severe upper abdominal pain
  • Persistent heartburn
  • Nausea
  • Vomiting bile
  • Cough or hoarseness in your voice‌
  • Unexplained weight loss‌

GERD. This is a different condition from bile reflux, although the symptoms are very similar. Bile may be mixed in with the stomach acid if you suffer from this condition. In fact, medical professionals suspect that bile contributes significantly to GERD.

Barrett's esophagus. This is a serious health condition that is usually diagnosed after suffering from reflux and GERD for a long time. Acid and bile damage your esophageal tissue so badly that the tissue is at risk for developing cancer.‌

Esophageal cancer. Because of the link between reflux and GERD to Barrett’s esophagus, there’s also a link to esophageal cancer. When you suffer from these conditions for a long time, it’s easy to miss the symptoms of cancer. If your condition worsens or doesn’t improve with treatment, talk to your doctor about your concerns.

Biliary disease. You may develop health conditions that cause damage to your liver, pancreas, gallbladder, and bile ducts. While you may or may not have noticeable symptoms of the condition, it may also quietly damage your organs and tissue without any signs. If you experience any of the following, talk to your doctor: 

  • Abdominal swelling
  • Urine that is darker than usual‌
  • Diarrhea that contains undigested fat
  • Persistent gas, hiccups, and burping
  • Itchy skin
  • Yellowing of your skin and eyes, also called jaundice
  • Losing your appetite, causing you to lose weight without trying to
  • Nausea and vomiting 
  • Pain through your upper abdomen and mid-back area‌
  • Bowel movements that are pale or streaked with blood

In order to make a diagnosis, your doctor will talk to you about your medical history and concerns. After completing a physical exam, your doctor may ask about your family medical history to narrow down specific disorders you may be prone to. Tests include:

  • Blood tests to assess your pancreatic enzyme levels and liver function
  • CT scans to look for current inflammation and scarring from previous flares 
  • Endoscopic retrograde cholangiopancreatography to look for blockages
  • MRI to look for inflammation in your pancreas, abdomen, and/or pelvic area
  • Ultrasound to look for gallstones and assess gallbladder inflammation
  • Upper endoscopy to look at your gastrointestinal tract and stomach

Less severe cases of biliary issues may be treated with medication. In some cases, you may need surgery to remove your gallbladder. This surgery is most often used to address:

  • Gallstones in your gallbladder, a condition also called cholelithiasis
  • Gallstones in your bile duct, a condition also called choledocholithiasis
  • Gallbladder inflammation, a condition also called cholecystitis
  • Large polyps in your gallbladder ‌
  • Inflammation of your pancreas, also called pancreatitis, which is caused by gallstones‌

Gallbladder surgery is called a cholecystectomy. The incisions made to remove your gallbladder are very small. The surgery is generally considered low-risk, and many patients go home the same day following their procedure. If a larger incision is necessary, your healing may be extended.