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Hi Patti,   No one knows better than your doctor what to do to help you manage your care, but there is some information here that might help you when you see your doctor and help you with the questions you need to ask.     Dr. Todd Eisner is one of the resident experts here. In this posting, Dr Eisner addresses the subject of PPI's and how sometimes they fail to produce the desired result because of nonacid reflux like bile reflux. You can read his posting here.      From what I have read, bile reflux occurs mostly when someone has had a their gallbladder removed, since they move the bile duct to the stomach when they remove the gallbladder. There are postings about bile reflux (you can read one of them here, there are 134 comments with information about gall bladder removal.) Here is a posted experience from a person who had surgery for the GERD and issues afterwards that she thought might have been bile reflux.   Dr. Eisner also addresses the bile issue here in this posting about whether or not it is acid or bile reflux and the causes and treatments.   Hope this helps! Stay in touch and let us know how you are doing!Vicki M