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Bile Acid Malabsorption

Location
Texas
Does anyone know what can or causes Bile Acid Malabsorption when you still have your gallbladder? My GI cannot determine the cause yet - I've tried many meds - we are at a loss? Constant nausea, lots of pain - eating will always cause nausea/pain within an hour of eating? Lots of D even with meds. Blood in stools on/off, today it is back again and I have a lot of burning in my esophagus - RBC has been slowly declining and has been below normal. I think my GI needs to go back in and look around - spoke with his PA, appt is Thursday but will call Monday to see if I can get in earlier.

Liver, gallbladder, pancreas scans all look fine. No energy, feel bad everyday, feel like crying.

I posted this in the Bile Acid Malabsorption Group but thought someone else might also have some thoughts -- I am so at a loss.

Thanks.
 

theOcean

Moderator
Is Questran an option for you? I've heard of a lot of people on this forum taking it.

I'm so sorry to hear about all the pain and nausea you're dealing with. :( One of my best friends has undiagnosed nausea/pain she's never been able to find a cause for, and the only treatment that doesn't cause her body to feel worse is using medical marijuana.

I'm glad you have an appointment, though. It definitely sounds like you might need stronger treatment than what you're currently receiving, though it looks like there's a lot of overlap between your Bile Acid Malabsorption and IBD symptoms, so it's hard to recommend what for.

I hope that my responding to this at least helps draw this thread to someone else's attention, and that you can get the help you need.
 
Location
Texas
Yes, I have tried the Questran/Cholestyramine and it caused severe bloating. My GI has said he thinks there are many things going on and has actually had the text books out.

I hope someone else has been able to overcome these issues and can offer some advice - this disease is so crazy.

Thanks for your input!
 

DustyKat

Super Moderator
If your small bowel disease is located in the terminal ileum and you have inflammation and/or scarring present then that may be where the problem lay. Also nausea and pain about an hour after eating are not uncommon symptoms when there is disease in the distal ileum.

The distal part of the ileum is where bile salts are reabsorbed out of the intestine and back into the body. If this mechanism fails then the bile salts flow freely into the large bowel. This where the next problem occurs. In the large bowel water is absorbed back out of the bowel and into the body and in doing so the stool firms up before reaching the rectum ready for defecation. The presence of large amounts of bile salts in the large bowel causes the osmotic effect of drawing water into the bowel and so the stool becomes loose and watery…bile salt malabsorption diarrhoea.

My daughter found Quetsran unpalatable and it caused bloating, products like Metamucil, Imodium and Lomotil caused bloating and cramping. The thing that has worked for her, and my son, is psyllium husk. But any of the stool bulking products must be used with caution if there is the possibility that you have stricture so it would be best to have that ruled in or out before proceeding.

I hope you can get an earlier appointment and good luck!

Dusty. xxx
 
Location
Texas
As far as my last tests showed just the upper GI tract - duodenum and blunted villi. Pill Cam 2/2014, last colonoscopy and upper GI endoscopy was 9/2013. Maybe it has spread because the constant nausea/pain started to get bad 11/2013. I'm looking into the psyllium husk - my GI is watching my meds/vitamins like a hawk to make sure none of them are interacting and causing the issue - so far nothing is showing as the culprit. I'll see if he thinks that is good for me.

Maybe it is time for another Colonoscopy/Upper Endoscopy to see if it has spread.

Thank you so much for the information!! Have a great day!
 

DustyKat

Super Moderator
I imagine they ruled out coeliac with the blunted villi?

If so are they looking into other reasons why the villi are blunted or is there already another explanation for it?

I should mention that you will still have time restrictions with meds and psyllium as it works in the same way as Quetsran. However with psyllium it reduces back to 1 hour before and two hours after.

I certainly think that further testing is needed Ali. Since you have now been diagnosed with Crohn’s I don’t know that the Pentasa alone will cut it. That is not to say that it doesn’t work for some but overall it is a pretty ineffective drug for Crohn’s.

Dusty. xxx
 
Location
Texas
Yes, they ruled out celiac and I even did a week trial just to make sure. My GI thinks the Crohn's blunted the villi. Do you know of anything else with my profile that could have caused it? I have googled blunted villi and came up with a couple of diseases SIBO & Whipples Disease - I have some of the symptoms of both of the diseases but not all. I think you are right on the Pentasa that I need to graduate to something else.

Thanks you!
 
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