Unexplained gastrointestinal symptoms and joint hypermobility: is connective tissue the missing link?
Abstract
BACKGROUND Unexplained gastrointestinal (GI) symptoms and joint hypermobility (JHM) are common in the general population, the latter described as benign joint hypermobility syndrome (BJHS) when associated with musculo-skeletal symptoms. Despite overlapping clinical features, the prevalence of JHM or BJHS in patients with functional gastrointestinal disorders has not been examined. METHODS The incidence of JHM was evaluated in 129 new unselected tertiary referrals (97 female, age range 16-78 years) to a neurogastroenterology clinic using a validated 5-point questionnaire. A rheumatologist further evaluated 25 patients with JHM to determine the presence of BJHS. Groups with or without JHM were compared for presentation, symptoms and outcomes of relevant functional GI tests. KEY RESULTS Sixty-three (49%) patients had evidence of generalized JHM. An unknown aetiology for GI symptoms was significantly more frequent in patients with JHM than in those without (P < 0.0001). The rheumatologist confirmed the clinical impression of JHM in 23 of 25 patients, 17 (68%) of whom were diagnosed with BJHS. Patients with co-existent BJHS and GI symptoms experienced abdominal pain (81%), bloating (57%), nausea (57%), reflux symptoms (48%), vomiting (43%), constipation (38%) and diarrhoea (14%). Twelve of 17 patients presenting with upper GI symptoms had delayed gastric emptying. One case is described in detail. CONCLUSIONS & INFERENCES In a preliminary retrospective study, we have found a high incidence of JHM in patients referred to tertiary neurogastroenterology care with unexplained GI symptoms and in a proportion of these a diagnosis of BJHS is made. Symptoms and functional tests suggest GI dysmotility in a number of these patients. The possibility that a proportion of patients with unexplained GI symptoms and JHM may share a common pathophysiological disorder of connective tissue warrants further investigation.
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Other studies of gastric sensorimotor function, compliance and emptying in small cohorts of patients with HSD/hEDS have otherwise revealed few specific abnormalities.
“Other studies of gastric sensorimotor function, compliance and emptying in small cohorts of patients with HSD/hEDS have otherwise revealed few specific abnormalities. 14 , 26 , 29 , 36 , 43 , 54 , 55”
From Hypermobile Ehlers–Danlos syndrome and disorders of the gastrointestinal tract: What the gastroenterologist needs to know (2022) · cites this paper as [26]
Colonic transit studies have also revealed no specific abnormalities in HSD/hEDS patients.
“Similarly, colonic transit studies have also revealed no specific abnormalities in HSD/hEDS patients. 14 , 26 , 36 , 50”
From Hypermobile Ehlers–Danlos syndrome and disorders of the gastrointestinal tract: What the gastroenterologist needs to know (2022) · cites this paper as [26]
People with hypermobile EDS are at higher risk of many comorbid problems, including gastrointestinal motility disorders, scoliosis, varicose veins, Chiari malformation, craniocervical instability and painful joint dislocation.
“individuals with hEDS have a higher risk of a wide variety of co-morbid problems, including gastrointestinal motility disorders, scoliosis, varicose veins, Chiari malformation, craniocervical instability, painful joint dislocation, and others (Castori, 2012a; Zarate et al., 2010; Milhorat et al., 2007; Henderson et al., 2017).”
From Postural tachycardia syndrome and other forms of orthostatic intolerance in Ehlers-Danlos syndrome (2018) · cites this paper as Zarate et al., 2010
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- Authors
- zarate, N., farmer, A. D., grahame, R., mohammed, S. D., knowles, C. H., scott, S. M., & aziz, Q.
- Affiliations
- Queen Mary University of London (GB)
- University College London (GB)
- Corresponding author
- aziz, q.
- Venue
- Neurogastroenterology & Motility
- Publisher
- Wiley
- Published
- 2010-03
- Volume
- 22
- Issue
- 3
- Pages
- 252-e78
- ISSN
- 1350-1925 (ISSN-L)
- 1365-2982
- OpenAlex
- W2033706886
- Cited by
- 178
- References
- 50
- Citations by year
- 2026: 2 · 2025: 9 · 2024: 7 · 2023: 11 · 2022: 16 · 2021: 17 · 2020: 16 · 2019: 9 · 2018: 10 · 2017: 18 · 2016: 8 · 2015: 13 · 2014: 11 · 2013: 8 · 2012: 8
- FWCI
- 8.14
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Neurogastroenterology & Motility (publishedVersion)
- PubMed (publishedVersion)
- Funders
- British Society for Rheumatology
- Rosetrees Trust
- Medical Research Council
- Topics
- Health Sciences › Medicine › Gastroenterology › Gastrointestinal motility and disorders
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Connective tissue disorders research
- Health Sciences › Medicine › Gastroenterology › Gastroesophageal reflux and treatments
- Keywords
- joint hypermobility, benign joint hypermobility syndrome, functional gastrointestinal disorders, connective tissue diseases, gastrointestinal motility disorders, delayed gastric emptying, abdominal pain, bloating, gastroesophageal reflux, constipation, diarrhea
- MeSH terms
- Adolescent, Adult, Aged, Connective Tissue, Female, Gastrointestinal Diseases, Gastrointestinal Motility, Humans, Joint Instability, Male, Middle Aged, Surveys and Questionnaires, Severity of Illness Index, Prevalence
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