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.