Colonoscopy is safe and not associated with higher pain scores in patients with hypermobility spectrum disorder: results from an exploratory prospective study

Abstract

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.

Hypermobile Ehlers–Danlos syndrome and disorders of the gastrointestinal tract: What the gastroenterologist needs to know

“…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 Other studies have reported rates of diverticular disease of 10-13% and rates of polyps of 8-23%. However, these data are drawn from retrospective chart reviews of patients who were not systematically evaluated and so the generalizability of these figures is uncertain.…”

“…This is in contrast to patients with vascular EDS in whom vascular and visceral perforation risk is high 87 . Procedural difficulty has been theorized to be more challenging due to the presence of hernias and increased laxity of the colon, but has not been verified in studies 35 . Indeed endoscopist‐reported difficulty and cecal intubation rates are not dissimilar between HSD and non‐HSD cohorts 35 .…”

“…The prevalence of diverticular disease, similarly, has not been systematically assessed. 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 . Other studies have reported rates of diverticular disease of 10–13% and rates of polyps of 8–23%.…”

“…Procedural difficulty has been theorized to be more challenging due to the presence of hernias and increased laxity of the colon, but has not been verified in studies 35 . Indeed endoscopist‐reported difficulty and cecal intubation rates are not dissimilar between HSD and non‐HSD cohorts 35 . There does not appear to be a significantly greater rate of post‐procedural pain 35 .…”

“…Indeed endoscopist‐reported difficulty and cecal intubation rates are not dissimilar between HSD and non‐HSD cohorts 35 . There does not appear to be a significantly greater rate of post‐procedural pain 35 . Increased risk of bleeding in association with colonoscopy has not been reported but should be assessed in the context of the patient's personal history of bleeding (which may be increased) and the planned procedure, particularly in those with mast cell activation syndrome 88 .…”