Aug. 17, 2000 -- No one likes to talk about it, but for millions of Americans, chronic diarrhea is not just an embarrassment, it's a crippling disorder that takes a devastating toll on quality of life. "I couldn't go anywhere," recalls Mary Petrozzello, 76. "I would get all dressed up and then have to stay home. I was afraid to budge -- it was horrible."
Making the problem worse was the fact that in some cases, nothing seemed to help the symptoms go away. But now a study in the August issue of the American Journal of Gastroenterology shows that people with chronic, intractable diarrhea may be suffering from gallbladder dysfunction. Treatment with a drug known as cholestyramine, or Questran, originally developed for patients who have had their gallbladders removed, may bring relief when other approaches have failed.
Study author Saad Habba, MD, a gastroenterologist in private practice in Summit, N.J., tells WebMD that chronic diarrhea afflicts approximately 10% of patients who have undergone gallbladder removal. He decided to perform this study when he noticed that many of his chronic diarrhea patients were "behaving as if they didn't have a gallbladder."
"The presenting complaint of these patients was diarrhea [after meals]," he tells WebMD. "Some of my patients were afraid to eat because they would immediately have to go to the bathroom."
To test his theory, Habba performed a study on 19 patients with chronic diarrhea, defined as more than four daily bowel movements for at least three months. The patients, who averaged anywhere from four to as many as 10 bowel movements per day, underwent extensive tests to rule out infections, irritable bowel syndrome, and other disorders known to cause diarrhea.
Further testing revealed that all these patients had varying degrees of gallbladder dysfunction. Three patients had gallstones. Interestingly, the severity of the gallbladder disease bore no relationship to the severity of each person's diarrhea.
The frequency of bowel movements dropped to one to two per day when the patients took Questran before meals, two to three times a day. "It's like a miracle," says Petrozzello, one of Habba's patients. In her case, it took a few weeks to see results. "At first I thought, this guy is nuts," she recalls.
Habba, however, encouraged her to be patient. "It took about a month for the diarrhea to go away. Now I can't believe I feel the way I do -- what a beautiful change." Petrozzello spoke to WebMD from her home in West Orange, N.J., just before leaving to spend the weekend at the beach. "I couldn't do that before," she says. "I wouldn't leave the house." She has been taking Questran once a day for five years and reports no ill effects.
"What Dr. Habba has done, using studies of the gallbladder, is to show that in [some] individuals with diarrhea, the gallbladder is not functioning," says Carroll M. Leevy, MD, professor of gastroenterology at the University of Medicine and Dentistry of New Jersey.
Leevy tells WebMD, "This research is exciting because we now know there's an additional ... mechanism for diarrhea related to gallbladder dysfunction, and it is treatable and correctable in a different manner than we used before."
Diarrhea after eating may be the only clue that a patient has gallbladder problems, Habba says. "We never connected chronic diarrhea to gallbladder dysfunction before. Now we do." He recommends testing gallbladder function before tagging patients as having irritable bowel syndrome or other conditions.
"I want to make this known to other practitioners," he says. "Many of my patients were diagnosed with irritable bowel syndrome, but did not respond to irritable bowel syndrome therapy. I changed their medication to cholestyramine [Questral], and all of a sudden their symptoms got 100% better. It's a dramatic difference."
Petrozzello puts it more succinctly: "Thank God for Dr. Habba"