What Is "Habba Syndrome"?

Is This a Real Diagnosis?

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Overview

"Habba Syndrome" is a term coined by Saad F. Habba, M.D. Dr. Habba has postulated the theory that diarrhea-predominant IBS (IBS-D) and functional diarrhea are catch-all terms for other identifiable medical conditions. According to Dr. Habba, one potential cause of these diarrhea symptoms would be that of a gallbladder that is intact but dysfunctional. It is this gallbladder dysfunction that he has labeled as "Habba Syndrome." 

It is important to note that "Habba Syndrome" is not recognized as a disease, but only a description of the observations of Dr. Habba himself.

Who Is Dr. Habba?

According to Dr. Habba's website, he is a gastroenterologist with over thirty years of experience as a doctor and gastroenterologist. He currently maintains a private practice in New Jersey, serves as a Clinical Assistant Professor at the Mount Sinai School of Medicine and is an attending physician at Overlook Medical Center in New Jersey.

Research

Dr. Habba based his theory on one study that he conducted in which he took a retrospective look at patients in his own practice. The study included a total of 303 patients who were diagnosed with IBS-D or functional diarrhea and who experienced their symptoms directly after eating(postprandial). He concluded that 98% of these patients had a diagnosable condition other than IBS. Of this group, he identified 41% of these patients as having Habba Syndrome, while another 23% experienced symptoms following the removal of their gallbladders.

Other diagnoses included lactose intolerance, microscopic colitis and celiac disease.

Subsequent Research

It turns out that Dr. Habba may have been on to something. Researchers have been looking at a condition called bile acid diarrhea (BAD), otherwise known as bile acid malabsorption (BAM), which seems to be the same dysfunction that Dr. Habba identified.

Studies have shown that BAM may be what is behind some cases of IBS-D. These studies are estimating that approximately one-third of people who have IBS-D may actually have BAD. Although Dr. Habba attributes symptoms to gallbladder dysfunction, researchers are looking into specific factors that might be causing the problems with bile acids.

Again, it must be pointed out that while research has identified the role of bile acids in some cases of IBS-D, there is no research to suggest that "Habba Syndrome" is in fact an actual medical disease.

Symptoms

Dr. Habba's theory describes the symptoms of "Habba Syndrome" as consisting of chronic diarrhea that predominately occurs after meals. Symptoms must be present for at least three months. Diarrhea is often urgent, explosive, and may result in incontinence. In Dr. Habba's description of the syndrome, diarrhea rarely happens at night.

Diagnosis

Dr. Habba recommends a full diagnostic workup to rule out other digestive disorders. He then recommends hepatobiliary scintigraphy, a nuclear medicine test, to determine the functioning level of the gallbladder, as quantified by a measure called the ejection fraction.

Dr. Habba's approach differs from that recommended for diagnosing BAD.

It is thought that the best measure of the presence of BAD is something called the 75SeHCAT scan. Unfortunately this test is not available in the Unites States. Therefore some physicians use a trial of a certain class of medications called "bile acid sequestrants" or "bile acid binding agents." If the medication is effective on symptoms, it is then assumed that BAD is present.

Treatment

Dr. Habba uses the aforementioned bile acid binding agents to treat what he perceives as the identified gallbladder dysfunction. This actually is in line with what is recommended by BAD researchers. Medications in this class include:

A Word from Verywell

It is commendable that Dr. Habba was one of the first physicians to recognize the role that bile acids might be playing in some cases of IBS-D. And it is encouraging that his theories and treatment recommendations are being supported by subsequent research. Unfortunately for him, his self-named "Habba Syndrome" will probably be replaced by the more inclusive diagnosis of bile acid diarrhea (BAD). Hopefully, continued research  as to the role of BAD will be conducted to verify the safety and effectiveness of Dr. Habba's approach to the treatment of the symptoms of IBS-D and functional diarrhea. Given that BAD is thought to be under-diagnosed by physicians, if the symptoms of the so-called "Habba Syndrome" sound like your own, it might be worth your while to have a discussion with your doctor about BAD.

Sources:

DiBaise JK, Islam RS "Bile Acids: An Underrecognized and Underappreciated Cause of Chronic Diarrhea" Practical Gastroenterology 2012 36(10):32-44

Habba, S. "Diarrhea Predominant Irritable Bowel Syndrome (IBS-D): Fact or fiction" Medical Hypotheses 2011 76:97-99.

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