Discovering a Rare Condition

Millennial woman with primary care doctor
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For four years, Riena Cribb, 39, suffered from debilitating abdominal pain. Anytime she ate, she felt downright horrible. Sometimes it was so bad, it would land her in the hospital.

The pain episodes were worse than any child-bearing pain, explains the Orlando resident, who says she spent much of her time in restaurants in the ladies room. My friends and family would have to wait at the table for long periods of time until I recovered.

She says it felt like there were charley horses in her intestines for about 30 minutes after every meal, not to mention the profuse sweating and vomiting she experienced.

One round of testing had revealed her gallbladder was not functioning properly, but even after having it removed, Riena was still in extreme pain. After countless doctor visits, she was running out of hope.

A Turning Point
Things began to look up, however, when she was referred to Maryam Kashi, DO, gastroenterologist at AdventHealth Winter Park. Immediately, Dr. Kashi knew this was not a lower GI issue.

She performed an EGD, or an esophagogastroduodenoscopy, a test to examine the lining of the esophagus, stomach and first part of the small intestine. It revealed some reflux, but Dr. Kashi wasn't convinced that was the real problem. She did multiple blood tests, which still came up inconclusive. But she kept looking for answers.

It turns out that Reina has a condition called bile acid malabsorption (BAM).

She did not give up, says Riena. She took the extra plunge and started me on Colestid, and she saved my life.

The medication works by binding to the acids and thereby reducing the effect on the large intestine.

It can be difficult to diagnose because there are so many causes of intestinal distress, Dr. Kashi says. BAM is often misdiagnosed as irritable bowel syndrome. Only about 1 percent of adults suffer from BAM.

It may be due to either poor absorption of bile acids in the small intestine or excess production of bile salts, she adds. Conditions which may affect it include celiac disease, Crohn's disease, small bowel surgery, cholecystectomy, vagotomy, small bowel bacterial overgrowth and radiation enteropathy.

Getting Her Life Back
Today, Riena says she feels amazing. She is extremely grateful to Dr. Kashi for being so thorough and attentive to her case.

I'm able to go out and eat with my family with no worries of extreme debilitating pain almost as soon as I finish a meal, she says. I can actually have a social life without worrying about living in a bathroom when I go out.

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