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Do You Have IBS-D, or Is It Habba Syndrome?

Sophie Lee, author of Sophie’s Story: My 20-Year Battle with Irritable Bowel Syndrome [1], hosts the IBSTales.com [2] site, featuring IBS basics, a news blog, and 1,000-plus patient reviews of IBS drugs, supplements, diets, therapies, and books, but “absolutely no medical advice.” This article is reproduced with her kind permission ©IBS Tales 2012, All Rights Reserved. It was first published Jan 16, 2012.


Habba Syndrome

Do you have IBS-D, or do you have Habba Syndrome? That’s what Dr. Saad F Habba, MD [3],(1) would like to know.

He’s coined the term Habba Syndrome to describe a condition that causes chronic diarrhea and is caused by a faulty gallbladder, and he believes that millions of IBS-D patients have been misdiagnosed and actually have Habba Syndrome.

This is the theory:

• When the gallbladder goes haywire, you end up with too much bile in the intestines, and the bile causes diarrhea. [A healthy gallbladder collects fat-digesting bile acids from the liver and delivers bile as needed through a tiny bile duct to the top of the small intestine.]

• This, of course, is the same thing that happens to some patients who have had their gallbladders removed.

• The treatment is the same too, with drugs such as Questran [4] used to bind the bile.

One particular feature of Habba Syndrome is diarrhea straight after a meal, which is called post-prandial diarrhea, and occurs because bile acids are naturally released directly after meals. This is something that many patients with diarrhea-predominant IBS experience.

Sound interesting?

For me, one of the best things about this theory is that there’s a specific test that can be used to see whether your gallbladder’s gone bad. It’s called a HIDA or DSIDA scan [5] with CCK injection, which in layman’s terms means that you get injected with some mildly radioactive stuff to highlight the bile, lie in one of those big white scanning machines, and wait while the docs study the flow of bile through your body.

This is a fairly new theory, so who knows whether we will all be having HIDA scans in the future. Theories like this tend to take years to really gain traction.

Lately, though, Dr Habba has taken his theory even further [6]. In  an article published in 2010, he suggested that IBS-D doesn’t exist at all. He studied 303 patients and concluded that 98% of them were suffering from a ‘true clinical entity’ rather than the ‘vague entity’ that is IBS.(2)

Of the 303 patients, he concluded that:

• 41% had Habba Syndrome,

• 23% had diarrhea caused by gallbladder removal,

• 8% lactose intolerance,

• 7% microscopic colitis [Inflammation of the colon visible only using a microsocpe, involving build-up of white blood cells [7] in the bowel lining, and caused, many think, by an abnormal immune response triggered by stressors such as bacteria, medication, or food],

• 4% celiac disease or gluten sensitivity,

• And then a handful of patients had multiple diagnoses, drug-induced bowel problems, infectious colitis or other problems.

In follow-ups, 98% of patients improved significantly when their specific problems were treated appropriately.

In other words – IBS-D, to all intents and purposes, is fictional. Wow.

Now, this was only one study, and I’m sure there are many doctors who are busy refuting the theory, because that’s how medicine works.

But I have to say that this is a fascinating idea, and it addresses what is, to me, one of the stupidest aspects of the IBS diagnosis, and that is the fact that people who have their gallbladders out and subsequently suffer from bile-related diarrhea get told they have IBS. How can that possibly be called IBS? [See “Gallbladder removal and IBS.” [8]]

You might as well diagnose someone with IBS if they’re taking 20 laxatives every morning, as if the mere presence of severe diarrhea automatically means IBS.

It seems obvious to me that post-gallbladder removal diarrhea is not IBS-D, just as diarrhea when you’ve had half your colon cut out isn’t IBS-D, so why doctors insist on calling it IBS I have no idea.

But maybe the problem isn’t just that doctors call gallbladder-related diarrhea IBS. Maybe the problem is that they call anything IBS…and none of us have irritable bowels at all.

Sophie Lee

1. Dr. Habba is an internationally-recognized and much-published gastroenterologist [3] who is currently an attending physician at overlook Hospital in Summit, NJ, and Clinical Assistant Professor of Medicine at Mount Sinai School of Medicine, New York. He is of the opinion that “Irritable Bowel Syndrome” is a term describing symptoms of different physiological causes, one of which is gallbladder dysfunction.

2. “Diarrhea Predominant Irritable Bowel Syndrome (IBS-D): Fact or fiction,” [9] Medical Hypotheses, Jan 11, 2011; and “Perhaps it is time to rethink IBS-D” [10] Scandinavian Journal of Gastroenterology, Jan 2012 (no abstract)

Note: This is general information, and is not meant to prevent, diagnose, treat or cure any illness, condition or disease.