The DOI matches its Crossref record; 49 of the 50 references it cites were found in a registry or an index.
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.
Overview
Integrity signals
Registry
Cites
Statistics
Verification
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
In the citing paper
“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]
In the citing paper
“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]
In the citing paper
“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
Citations
Cites
ROME III: The Functional Gastrointestinal Disorders
Sheth, A. (2007) · Journal of Clinical Gastroenterology · doi:10.1097/mcg.0b013e31804bbe26 · Cited by 1,974
Articular mobility in an African population.
Beighton, P., Solomon, L., & Soskolne, C. L. (1973) · Annals of the Rheumatic Diseases · doi:10.1136/ard.32.5.413 · Cited by 1,727
Abell, T. L., Camilleri, M., Donohoe, K., Hasler, W. L., Lin, H. C., Maurer, A. H., McCallum, R. W., Nowak, T., Nusynowitz, M. L., Parkman, H. P., et al. (2008) · The American Journal of Gastroenterology · doi:10.1111/j.1572-0241.2007.01636.x · Cited by 786
(2000) · PubMed · Cited by 738
Self-citationSoykan, I., Sivri, B., Sarosiek, I., Kiernan, B., & Mccallum, R. W. (1998) · Digestive Diseases and Sciences · doi:10.1023/a:1026665728213 · Cited by 575
(2006) · Cited by 534
Dysautonomia in the joint hypermobility syndrome
Gazit, Y., Nahir, A. M., Grahame, R., & Jacob, G. (2003) · The American Journal of Medicine · doi:10.1016/s0002-9343(03)00235-3 · Cited by 390
Self-citationMechanisms of hypersensitivity in IBS and functional disorders
Azpiroz, F., Bouin, M., Camilleri, M., Mayer, E. A., Poitras, P., Serra, J., & Spiller, R. E. (2007) · Neurogastroenterology & Motility · doi:10.1111/j.1365-2982.2006.00875.x · Cited by 367
(2007) · PubMed · Cited by 356
Review article: epidemiology and quality of life in functional gastrointestinal disorders
Chang, L. (2004) · Alimentary Pharmacology & Therapeutics · doi:10.1111/j.1365-2036.2004.02183.x · Cited by 352
Cited by
Sorted by citations
Items 101–178 of 178
Choudhary, A., Fikree, A., & Aziz, Q. (2021) · American Journal of Medical Genetics Part C Seminars in Medical Genetics · doi:10.1002/ajmg.c.31938 · Cited by 13
Self-citationAdvances in assessment of hypermobility‐related disorders
Simmonds, J. V. (2021) · American Journal of Medical Genetics Part C Seminars in Medical Genetics · doi:10.1002/ajmg.c.31943 · Cited by 11
Khan, A. W., Corcoran, S. J., Esler, M., & El-Osta, A. (2016) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2016.06.015 · Cited by 11
Joint Hypermobility and Clinical Correlates in a Group of Patients With Eating Disorders
Baeza‐Velasco, C., Sénèque, M., Courtet, P., Olié, É., Chatenet, C., Espinoza, P., Dorard, G., & Guillaume, S. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.803614 · Cited by 10
Lamari, N. M., & Beighton, P. (2023) · In clinical practice · doi:10.1007/978-3-031-34914-0_7 · Cited by 10
Silvernale, C. J., Garcia‐Fischer, I., & Staller, K. D. (2023) · Digestive Diseases and Sciences · doi:10.1007/s10620-023-08201-y · Cited by 9
Shulman, R. J., Self, M. M., Czyzewski, D. I., Goldberg, J. W., & Heitkemper, M. M. (2020) · The Journal of Pediatrics · doi:10.1016/j.jpeds.2020.03.033 · Cited by 9
Loganathan, P., Herlihy, D., Gajendran, M., Gonzalez, Z., Chavez, L. O., Espino, K., & McCallum, R. W. (2024) · Journal of Investigative Medicine · doi:10.1177/10815589231210486 · Cited by 8
Loose ends in the differential diagnosis of IBS-like symptoms
Lindberg, G., & Mohammadian, G. (2023) · Frontiers in Medicine · doi:10.3389/fmed.2023.1141035 · Cited by 8
Stress urinary incontinence as the presenting complaint of benign joint hypermobility syndrome
Smith, M. D., Hussain, M., Seth, J. H., Kazkaz, H., & Panicker, J. N. (2012) · JRSM Short Reports · doi:10.1258/shorts.2012.012005 · Cited by 8
Allen, S. J., Chazot, P. L., & Dixon, C. J. (2018) · British Journal of Clinical Pharmacology · doi:10.1111/bcp.13578 · Cited by 8
Síndrome de hipermovilidad articular
Rodríguez-Romo, R., Orrantia-Vertiz, M., Barragán-Garfías, J. A., Rojas-García, G., Rodríguez-Álvarez, A., & Carbonell-Bobadilla, N. (2020) · Acta Ortopédica Mexicana · doi:10.35366/99145 · Cited by 11
Gastrointestinal medication burden among persons with the Ehlers‐Danlos syndromes
Dhingra, R., Bascom, R., Thompson, E., Francomano, C. A., & Schubart, J. R. (2021) · Neurogastroenterology & Motility · doi:10.1111/nmo.14077 · Cited by 7
Clinical management of benign joint hypermobility syndrome: a case series.
Boudreau, P. A., Steiman, I., & Mior, S. A. (2020) · PubMed Central · Cited by 7
Ivanova, I. I., Sf, G., Апенченко, Ю. С., Капустина, Л. В., Gerasimov, N. A., & Soldatova, I. A. (2012) · Вопросы современной педиатрии · doi:10.15690/vsp.v11i5.428 · Cited by 7
Mast cell activation and nutritional disorders in patients with hypermobility
Penny, H. A., Aziz, I., & Lam, C. (2024) · Current Opinion in Gastroenterology · doi:10.1097/mog.0000000000001008 · Cited by 6
Outcomes of rectal prolapse surgery in patients with benign joint hypermobility syndrome
Singh, S., Smyth, E. A. E., Jones, O. M., Cunningham, C., & Lindsey, I. (2023) · Techniques in Coloproctology · doi:10.1007/s10151-023-02770-w · Cited by 6
Sweerts, K. W. E., Mujagic, Z., Keszthelyi, D., & Conchillo, J. M. (2025) · Alimentary Pharmacology & Therapeutics · doi:10.1111/apt.18471 · Cited by 6
Lyell, M. J., Simmonds, J. V., & Deane, J. A. (2016) · Physiotherapy Practice and Research · doi:10.3233/ppr-160073 · Cited by 7
EDS‐related Feeding Difficulties
Kilgore, A., Hawa, J. T., Liu, E., Belkind‐Gerson, J., & Santucci, K. K. (2021) · JPGN Reports · doi:10.1097/pg9.0000000000000147 · Cited by 6
Carbone, F., Goelen, N., Fikree, A., Aziz, Q., & Tack, J. (2021) · Neurogastroenterology & Motility · doi:10.1111/nmo.14086 · Cited by 5
Self-citationA new conceptual model for anorexia nervosa: A role for connective tissue?
Gibson, D., & Mehler, P. S. (2024) · International Journal of Eating Disorders · doi:10.1002/eat.24172 · Cited by 7
Scheufler, O., Andresen, J. R., & Andresen, R. (2020) · International Journal of Surgery Case Reports · doi:10.1016/j.ijscr.2020.09.165 · Cited by 5
Is there a relationship between joint hypermobility and gastrointestinal disorders in children?
Quitadamo, P., Thapar, N., Nardo, G. D., Pescarin, M., Bertelli, L., Tortora, C., Borrelli, O., Giorgio, R. D., & Staiano, A. (2021) · The Turkish Journal of Pediatrics · doi:10.24953/turkjped.2021.02.015 · Cited by 5
Recognizing the Scale of Joint Hypermobility Burden: Comment on the Article by Mulvey et al
Hakim, A. J., & Grahame, R. (2013) · Arthritis Care & Research · doi:10.1002/acr.22221 · Cited by 5
Self-citationAlsakarneh, S., Ta’ani, O. A., Madi, M. Y., Syn, W., Ruffle, J. K., Aziz, Q., & Farmer, A. D. (2025) · Alimentary Pharmacology & Therapeutics · doi:10.1111/apt.70506 · Cited by 4
Self-citationThe Use of Non-Narcotic Pain Medication in Pediatric Gastroenterology
Miranda, A., & Saps, M. (2014) · Pediatric Drugs · doi:10.1007/s40272-014-0080-6 · Cited by 4
Excessive laxity of connective tissue in constipated children
Załęski, A., Gawrońska, A., Albrecht, P., & Banasiuk, M. (2022) · Scientific Reports · doi:10.1038/s41598-022-05115-z · Cited by 5
Bassotti, G., Battaglia, E., Bachetti, F., Torti, G., & Villanacci, V. (2018) · Digestive and Liver Disease · doi:10.1016/j.dld.2018.10.012 · Cited by 4
Benítez, C. A. V., Ruiz-Extremera, Á., & Saps, M. (2019) · Anales de Pediatría (English Edition) · doi:10.1016/j.anpede.2019.04.010 · Cited by 4
Geenen, R., & Lumley (2018) · Utrecht University Repository (Utrecht University) · doi:10.3233/978-1-61499-878-5-i
Functional Nausea, Gut, Brain, or Both?
Santucci, N. R. (2020) · The Journal of Pediatrics · doi:10.1016/j.jpeds.2020.05.032 · Cited by 4
Choudhary, A., Makwana, K., Nee, J., & Aziz, Q. (2025) · American Journal of Gastroenterology · doi:10.14309/ajg.0000000000003315 · Cited by 3
Self-citationCastori, M., & Colombi, M. (2015) · Journal de Réadaptation Médicale Pratique et Formation en Médecine Physique et de Réadaptation · doi:10.1016/j.jrm.2015.08.003 · Cited by 3
Awi, Z. A.-R., Gorial, F. I., & SALMAN, A. A. (2016) · Archives of Rheumatology · doi:10.5606/archrheumatol.2016.5742 · Cited by 3
Dervin, H., Zárate-López, N., Sweis, R., Mensah, A., Fragkos, K. C., Brugaletta, C., Raeburn, A. J., & Emmanuel, A. V. (2023) · Neurogastroenterology & Motility · doi:10.1111/nmo.14570 · Cited by 3
Benítez, C. A. V., Ruiz‐Extremera, A., & Saps, M. (2019) · Anales de Pediatría · doi:10.1016/j.anpedi.2019.04.006 · Cited by 3
The impact of generalized joint hypermobility on eating behavior of students: A case-control study
Can, S., & Tuna, F. (2022) · Journal of American College Health · doi:10.1080/07448481.2022.2037613 · Cited by 3
Sweerts, K. W. E., Vork, L., Mujagic, Z., Conchillo, J. M., & Keszthelyi, D. (2025) · Digestive Diseases and Sciences · doi:10.1007/s10620-025-09206-5 · Cited by 2
Griffith, J. L., Daram, S., Boatright, B., Hughes, J. D., Lahr, C. J., Kedar, A., & Abell, T. L. (2013) · Lecture notes in computational vision and biomechanics · doi:10.1007/978-94-007-6561-0_8 · Cited by 2
Extra-articular Manifestations of Hypermobility
Beighton, P., Grahame, R., & Bird, H. A. (2011) · Springer eBooks · doi:10.1007/978-1-84882-085-2_6 · Cited by 2
Self-citationNutritional Supplementation in Ehlers-Danlos Syndrome
Castori, M., Bruschini, M., & Blundo, C. (2014) · Elsevier eBooks · doi:10.1016/b978-0-12-411462-3.00017-5 · Cited by 2
Approach to the Child With a Functional Gastrointestinal Disorder
Hyman, P. E., & Fleisher, D. R. (2010) · Elsevier eBooks · doi:10.1016/b978-1-4377-0774-8.10008-9 · Cited by 2
Nesterenko, Z. (2021) · Экспериментальная и клиническая гастроэнтерология · doi:10.31146/1682-8658-ecg-188-4-129-135 · Cited by 2
The Effect of Hypermobility on Pain and Quality of Life in Young Adults
Karaman, Ç. A., ZEREN, E., MARAL, F., Parlak, M., Kirazlı, Ö., BORACI, H., Zeren, M., & Arifoğlu, Y. (2022) · Bezmialem Science · doi:10.14235/bas.galenos.2022.55707 · Cited by 2
Steiner, L., Bodensteiner, A., & Johnson, N. (2023) · Journal of Orthopedic Research and Therapy · doi:10.29011/2575-8241.001313 · Cited by 2
Etiology and Clinical Presentation of Gastroparesis
Pace, L. (2019) · Springer eBooks · doi:10.1007/978-3-030-28929-4_2 · Cited by 2
Translating Research into Change: Reporting the Lived Experience of hEDS and HSD in Scotland
Berg, K. M., Dockrell, D., & Matheson, R. (2024) · doi:10.2218/ed.9781912669837 · Cited by 2
Shirvani, A., Shirvani, P., Jonah, U., Moore, B. E., & Holick, M. F. (2025) · Biomedicines · doi:10.3390/biomedicines13020469 · Cited by 2
Chavarría-Aguilar, S., Zavaleta‐Monestel, E., & Anchía-Alfaro, A. (2025) · Cureus · doi:10.7759/cureus.93187 · Cited by 1
Analysis of gastric myoelectrical activity in Joint Hypermobility Syndrome
CİLACI, T., Akan, A., & Kafee, A. A. (2017) · Medical Technologies Congress (TIPTEKNO) · doi:10.1109/tiptekno.2017.8238074 · Cited by 1
Clinical presentations of gastroparesis
Moshiree, B., & Douglas, Y. (2020) · Elsevier eBooks · doi:10.1016/b978-0-12-818586-5.00003-x · Cited by 1
Gonzalez, Z., & McCallum, R. W. (2020) · Elsevier eBooks · doi:10.1016/b978-0-12-818586-5.00020-x · Cited by 1
Ward, S. L., MacDermott, E. J., Simmonds, J. V., Deane, J. A., Mockler, D., & Dockrell, S. (2022) · Physiotherapy Practice and Research · doi:10.3233/ppr-220699 · Cited by 1
Ward, S. L., MacDermott, E. J., Deane, J. A., Simmonds, J. V., Mockler, D., & Dockrell, S. (2022) · Physiotherapy Practice and Research · doi:10.3233/ppr-210601 · Cited by 1
Approach to the Child with a Functional Gastrointestinal Disorder
Hyman, P. E., & Santucci, N. R. (2021) · Elsevier eBooks · doi:10.1016/b978-0-323-67293-1.00007-4 · Cited by 1
Ehlers-Danlos: A Literature Review and Case Report in a Colombian Woman with Multiple Comorbidities
Fajardo-Jiménez, M. J., Moreno, J., Mejía‐García, A., Villegas‐Lanau, A., Zapata, W., Restrepo, J. E., Montoya, G. P. C., & Hernández, J. C. (2022) · Genes · doi:10.3390/genes13112118 · Cited by 4
Butt, M. F., & Aziz, Q. (2018) · Elsevier eBooks · doi:10.1016/b978-0-12-801238-3.65656-8 · Cited by 1
Self-citationОсобенности проявлений заболеваний пищеварительного тракта у детей с дисплазией соединительной ткани
Russian Federation (2012) · CyberLeninK (CyberLeninka)
Postsurgical, Parkinson, Other Neurologic Diseases, Connective Tissue Disorders
Quigley, E. M. M. (2015)
Diagnostic procedures for fascial elasticity
FINDLEY, T. W. (2012) · Elsevier eBooks · doi:10.1016/b978-0-7020-3425-1.00070-2
Krahe, A. (2017) · The Sydney eScholarship Repository (The University of Sydney)
Benign Joint Hypermobility Syndrome (BJHS)
Błasiak, A. (2020) · Springer eBooks · doi:10.1007/978-3-662-61074-9_5
Gastroparesis from other causes
Ahuja, N. K. (2020) · Elsevier eBooks · doi:10.1016/b978-0-12-818586-5.00021-1
Hypermobility Spectrum Disorders/Ehlers–Danlos Syndrome and Disordered Eating Behavior
Baeza‐Velasco, C., Espinoza, P., Bulbena, A., Bulbena‐Cabré, A., Sénèque, M., & Guillaume, S. (2021) · Springer eBooks · doi:10.1007/978-3-030-81174-7_28
The rheumatological heritable disorders of connective tissue
Grahame, R., & Kazkaz, H. (2014) · Medicine · doi:10.1016/j.mpmed.2014.02.005
Self-citationThe rheumatological heritable disorders of connective tissue
Grahame, R., & Hakim, A. J. (2010) · Medicine · doi:10.1016/j.mpmed.2009.12.010
Self-citationOrtíz-Rivera, C. J., Benítez, C. A. V., & Idarraga, A. K. M. (2022) · Latin American Journal of Pediatric Gastroenterology and Nutrition · doi:10.24875/lajpgn.m22000002
Komorbiditäten (Begleiterkrankungen)
Sturm, K., Jung, H., & Maier, A. (2022) · Springer eBooks · doi:10.1007/978-3-662-65041-7_3
Joint Hypermobility Syndrome and Hypermobility Spectrum Disorders
Lamari, N. M., & Beighton, P. (2023) · In clinical practice · doi:10.1007/978-3-031-34914-0_8
Failure to thrive in a young child
Liu, E., & Elias, E. R. (2024) · Elsevier eBooks · doi:10.1016/b978-0-323-95082-4.00039-6
Approach to the Child With a Disorder of Gut-Brain Interaction
Jerson, B., & Baker, C. C. (2025) · Elsevier eBooks · doi:10.1016/b978-0-443-11760-2.00007-0
Oelerich, K., Bains, K., Minchenberg, S. B., Deshpande, V., Iturrino-Moreda, J., & Kulkarni, S. (2025) · ACG Case Reports Journal · doi:10.14309/crj.0000000000001823
DePace, N. L., Soloway, S., Yayac, M. F., & Colombo, J. (2025) · Springer eBooks · doi:10.1007/978-3-031-88769-7_7
Joint hypermobility syndrome for the urogynaecologist – A narrative review
Abaza, I. A. N., Tadros, M., Lemmon, B., Bhide, A., Fernando, R., & Khullar, V. (2026) · European Journal of Obstetrics & Gynecology and Reproductive Biology · doi:10.1016/j.ejogrb.2026.114943
Diagnostische Verfahren zur Bestimmung der Faszienelastizität
(2026) · Elsevier eBooks · doi:10.1016/b978-3-437-55038-6.00006-3
Metadata
- 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
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
