Habba Syndrome – What is, Symptoms Diagnosis and Treatment

Habba syndrome is a bowel defect characterized by chronic diarrhea caused by a dysfunctional, yet intact gall bladder. The ailment is named after Dr Saad F. Habba, MD, a graduate of the Royal College of Surgeons in Ireland who has been practicing Gastroenterology for the past 34 years. The dysfunction of the gall bladder causes painful stools, three or more times a day which are usually watery and without blood. Patients suffering from this disease have found some relief by controlling the bile function of the gall bladder with medication.



Though there are no specific numbers available for the syndrome as it is relatively new for diagnosis, Dr Habba had some interesting figures in a study conducted. In the recent study published in the Medical Hypothesis Journal, Dr Habba analyzed 575 patients with preexisting chronic diarrhea and IBS-D diarrhea who experienced their symptoms postprandial (after consumption of food).   The study results were based on 303 patients who completed all the testing and follow up out of the 575 original volunteers. The study pointed that 98% of the patients had conditions other than IBS-D and when treated appropriately, displayed remarkable improvement testified by fewer than three bowel movements per day. Out of these, 41% patients have been diagnosed with Habba Syndrome and 23% patients had problems related to gall bladder removal (post-cholecystectomy diarrhea). So, it might be said that 4 out of every 10 cases registered as chronic diarrhea or IBS-D could actually be suffering from Habba Syndrome.

Currently IBS-D affects around 15% of the American population or approximately 45 million people. So, the actual number of people affected by Habba Syndrome could be very high, but the worst part is a vast number of people have accepted chronic diarrhea as part of their life, ceasing to look for diagnosis and treatment options.

Habba Syndrome Symptoms

There are four major symptoms of Habba syndrome which are common for IBS and chronic diarrhea too.
Post-prandial diarrhea
Post-prandial diarrhea in colloquial terms means explosive or compulsive diarrhea which is experienced directly after eating. Post-prandial diarrhea has long been associated with IBS and hence is treated with the IBS management program.

Gall bladder dysfunction
Gall bladder dysfunction is a major symptom of Habba syndrome. The primary function of Gall bladder is to store bile which is a natural laxative and used in the digestion process. The dysfunction is caused by gallstones formed in the gall bladder which impair its ability to hold bile. Thus the bile created by the liver is directly passed on to the small intestine as the gall bladder is unable to store it or control it. The uncontrolled flow of bile results in chronic diarrhea. In Dr. Habba’s study, 68% subjects had treatable bile acid abnormalities.

Failure to respond to Standard IBS management therapy
IBS-D management therapy can fail on various accounts as not all of the patients diagnosed would actually have that condition. The “umbrella” diagnosis of IBS-D might overlook the specific conditions suffered by certain patients as pointed out by Dr Habba in his study. The identification of these specific factors and related treatment caused improvement amongst patients who were earlier diagnosed with IBS-D.

Favorable response to bile acid binding agents
Drugs like cholestyramine are known to bind the excess bile produced in the body by absorbing it.

Habba Syndrome Diagnosis

The diagnosis for Habba Syndrome covers physical tests, non-invasive external tests as well as invasive tests.
Stool Analysis
A stool test is recommended to determine the presence of Habba Syndrome by ruling out other possible conditions. The test requires collection of a fecal sample in a vial provided by a medical practitioner and analysis of this sample. Stool analysis tests are reflective of the condition of the gastrointestinal system. A fecal fat test might be recommended as mal-absorption of fecal fat is indicative of the bile acid dysfunction.

Doctors use a flexible camera which is used to observe and examine the colon for polyps, tumors and other types of abnormal growths which could be a major indication of a serious medical condition. A clonoscope – a flexible tube like structure of not more than one centimeter in diameter with a fiber optic camera and suction is inserted in the body through the rectum. Then, the doctor observes the colon through his computer screen for any inflammation or abnormal growth.

Malabsorptive disorder tests
This test is conducted to rule out the possibility of Celiac disease or any other type of malabsorptive disorder, further confirming the possibility of Habba Syndrome. People with malbsorptive disorders cannot digest food properly and hence, undigested fats and carbohydrates carry water out of the bowel. These tests are conducted as a part of differential diagnosis.

Ultrasound and other radiological test for Gall bladder
To detect Gall bladder dysfunction, your doctor might recommend ultrasound or other radiological tests which are used for imaging. The detection of Gall stones in the results would confirm Gall bladder dysfunction.

Living with the disease

Living with Habba Syndrome is not very troublesome, but the detection is. There are cases of patients who had been wrongly diagnosed with IBS-D, chronic diarrhea or bile acid diarrhea, all of which have similar symptoms. Mary Jenkins, a 50 year old Nova Scotia, Canada resident suffered for  six years before her actual diagnosis of Habba Syndrome. “I soon became what they call a bathroom mapper”, she said before discovering the syndrome. A chance viewing of Mystery Diagnosis by her husband brought her attention to Dr. Habba’s discovery and she gave it a try. Mary was soon put on medication and the results were visible immediately. Mary is now completely cured of Habba’s Syndrome. Mary’s relief is quite visible in her words when she said, “Thank God for smart people. I was beginning to think this would be the death of me.”

Habba Syndrome Treatment

Since the basic cause of the syndrome is the inappropriate amount of bile present in the gastrointestinal tract caused by the dysfunctional gall bladder, all the treatment efforts are aimed at controlling the bile acids to decrease their diarrheal effects.
Bile acid binding agents have been used for a very long time and are proven to be effective, affordable and safe.  These agents should be used ½ hour prior to meals for a proper binding effect. Cholestyramine has been proven to give an excellent response to a large number of patients. Though a very effective drug, Cholestyrmine, is not the only option, patients could opt for other effective agents like Colestipol and Colesevelam.