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What Is Habba Syndrome?
It is an association between a dysfunctional, intact gallbladder and chronic diarrhea. Patients with the syndrome present with varying degrees of chronic diarrhea (three or more bowel movements per day for at least three months). Diarrhea is classically described as frequent, loose bowel movements and may be watery in nature. They could be explosive at times and may even be associated with great urgency and even incontinence. Diarrhea is mostly after meals (post prandial diarrhea). Because of this urgency, patients usually look for a bathroom wherever they go, also known as "bathroom mapping".
These symptoms are usually very distressing and may cause social embarrassment and interference with daily activities. Some patients are even homebound in fear of social embarrassment. Some lose weight because they are afraid to eat for fear of getting diarrhea.
Diarrhea is rarely nocturnal, unless the patient had a late meal close to bedtime.
It is not associated with blood, unless it comes from irritation of the rectal area as a result of frequent bowel movements.
Dr. Habba found that this type of diarrhea is associated with dysfunctional gallbladder.
Is there pain associated with this syndrome?
The patient would not necessarily have abdominal pain related to the gallbladder disease. They could be completely free of any abdominal pain. The gallbladder function is only determined by an abnormal radio-nuclear test that studies the function of the gallbladder (HIDA/DISIDA scan with CCK injection). This test is non-invasive and can be performed in all well-equipped hospitals and radiology centers.
If ultrasound of the gallbladder is normal, could I still have the syndrome?
Absolutely. In fact, most of the patients with the syndrome have normal ultrasound of the gallbladder. However, the presence of gallstones on ultrasound does not rule out the diagnosis of the syndrome.
The content provided is for informational purposes only. The material contained herein is not intended as a substitute for evaluation and treatment by a physician.This site and the content herein are based on Dr.Habba's own opinion and experiences. This site and Dr.Habba are not responsible for errors or inaccurate material.The Site and the Content are provided on an "AS IS" basis and do not create a physician patient relationship.
What are the cardinal symptoms of this syndrome?
1. Post-prandial diarrhea (varying from simple urgency to incontinence) and fear of eating to avoid diarrhea
2. Dysfunctional gallbladder as determined by radiological testing
3. Failure to respond to standard therapy for “IBS”
4. Favorable response to bile acid binding agents
What should be done if you have these symptoms?
Check with your primary doctor or gastroenterologist.
A basic work up of the symptoms needs to be done such as stool analysis, lab work, x-rays and colonoscopy. Further testing to rule out malabsorptive conditions (celiac sprue, etc.), inflammatory bowel disease (ulcerative colitis and Crohn’s disease) and cancer need to be done before the syndrome diagnosis can be confirmed.
These tests must be done to rule out all other treatable conditions before starting therapy for Habba Syndrome.
What is the treatment for the syndrome?
Since the basic pathology of the syndrome is inappropriate bile in the gastrointestinal tract related to a dysfunctional gallbladder, therapy should be aimed at changing the constitution of bile acids to decrease the diarrheal effect of these bile acids.
Agents that bind bile acids have been tried for many years and have been proven safe, effective and inexpensive. Some are available in generic forms.
These agents should be used ½ hour prior to meals to bind the bile acids and to become effective. In the original publication of the syndrome, cholestyramine was used with excellent response. However, similar results can be obtained with other agents such as Colestipol and Colesevelam.
How soon should I expect improvement?
Symptoms should improve within a few days of continuous therapy. One may have to stay on these medications for a long time. Dosage can be increased or tapered as symptoms stabilize.
Is removing a gallbladder surgically an accepted mode of therapy?
Cholecystectomy (removal of the gallbladder) should not influence the outcome of the symptoms. In fact, approximately 10% of patients have similar symptoms after gallbladder removal. Hence, surgical removal of the gallbladder to treat chronic diarrhea is not appropriate for this condition.
How many people suffer from this syndrome?
Most likely millions of people diagnosed with either “IBS” or spastic colon have Habba Syndrome. It is estimated that approximately 45 million American suffer from “IBS” or similar conditions. According to Dr. Habba’s study, 41% of patients had Habba Syndrome.
Most people accept chronic diarrhea as a “normal” form of life and learn to live with it and its limitations, socially or otherwise. Hence, the problem is much bigger than what we can appreciate.