From Middlebourne the creek turns to the southwest and flows roughly parallel to the Ohio River (excepting its numerous bends), through the unincorporated communities of Next, Little, Shiloh, and Falls Mills in Tyler County; and into Pleasants County, where it flows through the unincorporated communities of Arvilla, Sugar Valley, Union Mills, and DeLong and joins the Ohio River in the city of St.

[7] The lowermost 12 square miles (31 km2) of the creek are inundated by backup from the Willow Island Locks and Dam downstream on the Ohio River.

Sometime prior to 1800, a settler named George Gregg had a mill race carved across the narrow point of the peninsula and harnessed the resulting hydropower for a gristmill and sawmill.

In 1947 the West Virginia Conservation Commission constructed a low water bridge which substantially dammed the cut-through and restored a steady flow to the bend of the creek.

[10] Glass- and carbon-manufacturing facilities were built in West Union and Smithburg in the early 20th century, owing to the availability of natural gas.