Do you have IBS-D, or do you have Habba Syndrome? That’s what Dr Saad F Habba 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. 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 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 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. 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.
Of the 303 patients, he concluded that 41% had Habba Syndrome, 23% had diarrhea caused by gallbladder removal, 8% lactose intolerance, 7% microscopic colitis, 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 it 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? 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.
I am so sick of this. Death seems like a far better reprieve than living life like this. I have just undergone another colonoscopy and the latest diagnosis is divervictulosis. I have been through Hell. I have a brain injury due to passing out with senekot. Had a CAT scan done and my first Doctor said that I did not have one. So we lost everything we owned, and I was brought in to a hospital being in so much pain that I wanted to drive off of a road. Was told that if I returned to this particular hospital I would be admitted into the mental health ward. I begged to be because I truly believe that if I had been, maybe I would have gotton some help. Well, then My husband and I moved to Nova Scotia. Here I was asked by my new physician ” How long have You had this brain injury/”…I said what brain injury?? It DID show up. Then I was told by another Doctor that I had Gallstones 5 of them actually…Then I was told by ANOTHER Doctor that I did not have them anymore…Then I was told by my latest Doctor that I do still have them. I can figure that these physicians will find out what is really wrong with me when they do an autopsy..There is no other way. I would say I give up, but I wont because I stay alive just to spite them. I never used to be a bitter person, I used to love people. But this world has made me so angry. So many people, and we are all just like cattle in a system that is so overwrought with the stupid drug addicts and alcoholics, that people like us who really are suffering, get overlooked. May I add what started me on this journey was a TSH level of 144. That was not diagnosed either until I asked a blood technician, to ask a Nurse, to ask a Doctor to do a TSH test. My levels are now fine that way. But I was told for months that I was depressed. Meanwhile my kidneys were shutting down, My lungs were filling up with fluid, my BP was 100 over 180, My hair was falling out, my skin was like an open sore. I forgot who I was. The only reason I stayed alive over that one was because of my dog. I would not let her down. I somehow remembered her. I have been since diagnosed with IBS C. And every morning I start the day in good spirits, but the pain is burning, relentless, and I can not sit. I have yet to see an endocronologist. 2 years later.
Hi Sophie, I hope the blog is still up and running since I don’t see any entries since January.
Anyway, I have been diagnosed with IBS. However I have neither constipation nor diarrhea. What I do get are abdominal cramps and gas.
Often after a bad attack I will develop flu-like symptoms, i.e. fatigue and muscle aches that lay me low for a couple of days. Have you ever heard of these symptoms being associated with IBS?
Thanks so much, Jonathan.
Hi Jonathan – the blog’s still going, I’m just involved in a couple of other projects right now that need to come first.
Sorry to hear you’re a fellow sufferer. To be honest I hear lots of personal stories from people with all kinds of symptoms, so I’ve probably heard from someone with similar symptoms as some point…that’s not a very helpful reply is it!
Have you ever looked into fibromyalgia? I don’t know much about that but I think fibro is more associated with muscle aches and fatigue than IBS is. It’s also rather odd that you don’t have any bowel problems but have been diagnosed with IBS…the Rome Criteria are the gold standard for diagnosis (see here: http://www.ibstales.com/diagnosis-ibs.htm ) and they clearly say that a marked change in bowel habit is a necessary feature for an IBS diagnosis. If you don’t have diarrhea or constipation I don’t really understand why your doc thinks you have an irritable bowel…
Does your pain go when you go to the bathroom? Is there a change in stool consistency (sorry to be blunt, but these are the Rome questions). I’d be asking for a second opinion I think.
>>I’d be asking for a second opinion I think.
That’s exactly what I’m in the process of lining up. I was not happy with my GI doc as I felt she used the term “IBS” as a default “diagnosis.”
Thanks again for your help. I just finished your book last week and enjoyed (if that’s the word!) it immensely.
Glad you liked the book! Yeah, ‘enjoyed’ doesn’t sound quite right for a book like that does it?! But I’m very glad you appreciated it.
It can be tough to know when to accept a diagnosis of IBS and when to keep pushing for more tests etc, but I think in your case it’s good that you’re getting another opinion. Doctors do sometimes seem to use the term IBS to mean “I haven’t got the slightest clue, my dear” but if your symptoms don’t remotely fit the Rome Criteria then the doc is pretty much inventing a whole new type of IBS by themselves…
Is there anyone in this world that finds sitting horrible.. pain from below rib cage to hip area…I am going for a HIDA scan…But I am afraid too…If this comes up fine…I will be locked up in an institution and have elsctric shock therapy as my Doctor says I am making it up…I am now afraid to ride my bike…climb up a ladder at work…swim in the ocean…Anything that involves a risk from getting hurt…I have been to the hospital five times in a year and a half due to severe stomach pain….And it is real…I can assure You…I have been diagnosed with IBS C…And pain is so much with me, I figure I may as well name it…My legs are beginning to give out as I stand from 6 in the morning until I go to bed at 10…And this is normal?? Right…It is insane…But this has become my life as I have no one who can figure it out…So they blame me…I also have been diagnosed with diverticulosis…post concussion syndrome…Yet believe it or not?? I am a happy person…help anyone that needs it…Because self pity buys You one lonely life..I just wish I knew what was wrong…Nothing ever helps…I go every morning, but the burning is horrific in my stomach…and nothing ever makes a difference..what I eat, or do not eat…Somebody, somewhere, anywhere has got to know what is wrong…I personally think chronic pancreatitis, but suggesting this will get me admitted to a life behind bars in a nuthouse…so I remain silent..I know that life is not fair…but this is unjust…My blood work always comes back fine when I have to have it for my synthroid renewal…I do not drink…although I have considered taking it up, as maybe being drunk all the time would numb this pain…hahahah
I am a retired specialist in maternity care, gynaecology and medical computing.
I have had what used to be labelled IBS for 30 years, at times causing great distress but in the past no test including a jejunal biopsy have ever shown up anything significant. However about 6 months ago my bowel problems became so bad that I had two episodes of explosive fecal incontinence and therefore arranged to see a specialist again. It now turns out that my symptoms seem to have been caused by something newly identified and now called “Bile Acid Malabsorption” (See Wikipedia for more information in an article which has in fact I am told mainly been written by Professor Julian Walters of the Hammersmith hospital London.) One of the articles quoted is called “Bile Acid Malabsorption: a forgotten diagnosis” which is an excellent title. I have recently had the test which is called the SeHCAT test which confirmed the diagnosis but I have been told that that test is not yet available in the USA. If Professor Walters is right that about 1 in 100 people diagnosed as IBS actually has bile acid malabsorption then thousands of people have this problem without knowing it.