Colonoscopy is safe and not associated with higher pain scores in patients with hypermobility spectrum disorder: results from an exploratory prospective study
Open accessAbstract
Background: Patient perception of colonoscopy varies greatly. Young slender women and patients with irritable bowel syndrome (IBS) appear to be at risk for periprocedural pain. Recent evidence suggests a high prevalence of joint hypermobility related connective tissue disorders in this population. Therefore, we aimed to investigate whether hypermobility spectrum disorder (HSD) is associated with increased pain during colonoscopy. Methods: We prospectively included patients undergoing routine colonoscopy. Subjects were assessed for HSD using the 2017 criteria, and IBS and functional dyspepsia using the Rome III criteria. After colonoscopy and recovery from sedation, patients were asked to report pain scores on a 100-mm visual analogue scale (VAS). In addition, caecal intubation time was measured, endoscopists scored the difficulty of the procedure (100-mm VAS) and procedure-related adverse events were registered. Results: Of 200 included patients, 22 (11%) met criteria for HSD. A female predominance was observed in patients with HSD (86.4% versus 49.4%, p < 0.001). A crude linear regression model demonstrated that pain scores were 13.30 mm higher in patients with HSD versus non-HSD patients (95% CI 0.07 – 26.53, p = 0.049). When subsequently correcting for possible confounding factors, however, this difference in pain scores could be explained by a confounding effect of female gender. Caecal intubation time, perceived procedural difficulty and complication rate did not differ significantly between groups. Conclusion: HSD does not seem to be a predictor of painful colonoscopy, probably due to female gender as a confounding factor. In addition, performing colonoscopy is not more complicated in patients with HSD versus non-HSD patients, nor is it associated with more adverse events.
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In the only relevant report, 22 of 200 patients met criteria for HSD and that sub-group had a similar prevalence of polyps (27% vs 41%, P = 0.2) and diverticulosis (39% vs 36%, P = 0.7) as those without HSD.
“In the only relevant report, a study of issues associated with colonoscopy such as safety and post procedure pain, 22 of 200 patients met criteria for HSD and that sub‐group had a similar prevalence of polyps (27% vs 41%, respectively; P = 0.2) and diverticulosis (39% vs 36%, P = 0.7) as those without HSD. 35”
From Hypermobile Ehlers–Danlos syndrome and disorders of the gastrointestinal tract: What the gastroenterologist needs to know (2022) · cites this paper as [35]
There does not appear to be a significantly greater rate of post-procedural pain in HSD/hEDS.
“There does not appear to be a significantly greater rate of post‐procedural pain. 35”
From Hypermobile Ehlers–Danlos syndrome and disorders of the gastrointestinal tract: What the gastroenterologist needs to know (2022) · cites this paper as [35]
Endoscopist-reported difficulty and cecal intubation rates are not dissimilar between HSD and non-HSD cohorts.
“Indeed endoscopist‐reported difficulty and cecal intubation rates are not dissimilar between HSD and non‐HSD cohorts. 35”
From Hypermobile Ehlers–Danlos syndrome and disorders of the gastrointestinal tract: What the gastroenterologist needs to know (2022) · cites this paper as [35]
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- Authors
- Beckers, A. B., Vork, L., Fikree, A., de Ridder, R., Aziz, Q., Masclee, A., & Keszthelyi, D.
- Affiliations
- Maastricht University Medical Centre (NL)
- Royal London Hospital (GB)
- Department of Internal Medicine, Maastricht University Medical Center, Maastricht, Limburg, The Netherlands
- Queen Mary University of London (GB)
- Department of Internal Medicine, Division of Gastroenterology-Hepatology, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, PO box 5800, Maastricht, Limburg 6202 AZ, The Netherlands
- Venue
- Therapeutic Advances in Gastroenterology
- Publisher
- SAGE Publications
- Published
- 2020-01
- Volume
- 13
- Pages
- 1756284820927310-1756284820927310
- ISSN
- 1756-283X (ISSN-L)
- 1756-2848
- PMC
- PMC7370544
- OpenAlex
- W3042840637
- Cited by
- 5
- References
- 23
- Citations by year
- 2025: 1 · 2024: 1 · 2023: 2 · 2022: 1
- FWCI
- 0.27
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Therapeutic Advances in Gastroenterology (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Research Publications (Maastricht University) (publishedVersion, cc-by-nc)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Research Publications (Maastricht University) (submittedVersion, cc-by-nc)
- Topics
- Health Sciences › Medicine › Oncology › Colorectal Cancer Screening and Detection
- Health Sciences › Medicine › Gastroenterology › Gastrointestinal motility and disorders
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Connective tissue disorders research
- Keywords
- hypermobility spectrum disorders, colonoscopy, procedural pain, irritable bowel syndrome, functional dyspepsia, procedural difficulty, sedation recovery, adverse events, connective tissue diseases
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