Functional gastrointestinal disorders are increased in joint hypermobility‐related disorders with concomitant postural orthostatic tachycardia syndrome

Tai, Foong Way David; Palsson, Olafur S.; Lam, Ching; Sperber, Ami D.; Törnblom, Hans; Simrén, Magnus; Aziz, Imran

doi:10.1111/nmo.13975

Cited by 24 publications

(26 citation statements)

References 26 publications

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“…Although autonomic dysfunction in overlap hEDS/IBS has not been formally assessed, a study looking at FGID in hEDS found that out of 616 patients with hEDS, 98% had an FGID, and 37.5% had POTS. Whilst the overall prevalence of functional GI disorders did not differ between patients with hEDS with and without overlap POTS, there was an upward trend of IBS within this POTS/hEDS overlap group compared to the hEDS group without POTS (59% vs. 51%, p = .06) (Tai et al, 2020). This study suggests that symptoms in this overlap IBS/hEDS group may occur via autonomic pathways and that this is an avenue worth exploring in the comorbid IBS/hEDS group.…”

Section: Autonomic Dysfunctionmentioning

confidence: 61%

Overlap between irritable bowel syndrome and hypermobileEhlers–Danlossyndrome: An unexplored clinical phenotype?

Choudhary

Fikree

Aziz

2021

American J of Med Genetics Pt C

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Irritable bowel syndrome (IBS) is common, but its cause remains unknown. IBS patients present with gastrointestinal (GI) symptoms such as abdominal pain with altered bowel habits; however, some patients also have non-GI symptoms including muscle and joint pains. It is thus plausible that within large IBS cohorts, subgroups exist with distinct clinical phenotypes. Yet, these subgroups have not been clearly identified or characterized. Due to lack of segmentation, treatment-focused symptomatic management is similar for all with IBS and follows indiscriminate algorithms regardless of possible differing clinical phenotype. This universal approach to IBS management may account for the reported lack of efficacy of treatment. One emerging subgroup receiving increasing attention is that with overlap IBS and the underlying heritable connective tissue disorder, hypermobile Ehlers-Danlos syndrome (hEDS). Current evidence suggests that up to 62% of patients with hEDS suffer from IBS. However, despite recognition of the presence of IBS in hEDS, this overlap IBS/hEDS group has not been characterized and these patients are managed in a similar way to those with IBS alone. Future studies are required to characterize and deep phenotype in this overlap IBS/hEDS group.

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Section: Autonomic Dysfunctionmentioning

confidence: 61%

Overlap between irritable bowel syndrome and hypermobileEhlers–Danlossyndrome: An unexplored clinical phenotype?

Choudhary

Fikree

Aziz

2021

American J of Med Genetics Pt C

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“…[31][32][33][34] It is frequently missed in clinical practice but may provide an important aetiological connection between fibromyalgia, ME/CFS and multiple systemic symptoms, including those described above. 35,36 Recent work indicates that symptomatic hypermobility may be present in ∼80% of fibromyalgia and ME/CFS patients, yet have only been diagnosed in one out of four cases previously. 15 Differences in connective tissue matrix (eg collagen) throughout the body could explain disparate symptoms including irritable bowel and bladder, headache and dysfunctional uterine bleeding.…”

Section: Hypermobilitymentioning

confidence: 99%

The challenges of chronic pain and fatigue

Eccles

Davies

2021

Clinical Medicine

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In this review, we explore the challenges of chronic pain and fatigue in clinical practice. Both pain and fatigue are common, troubling and frequently overlapping symptoms, and we describe both the clinical burden and the 'clinical problem'. We explore commonly associated symptoms and possible pathological associations, including variant connective tissue (joint hypermobility), small fibre neuropathy, mast cell activation, dysregulated inflammatory and interoceptive processes, which may inform treatment targets. We suggest a multidisciplinary management approach.

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“…15,82 A recent large cross-sectional survey of adults with EDS found a high prevalence of POTS (37.5%) which was linked to a greater burden of functional GI conditions. 84 Although it is well documented that patients with JH and functional GI complaints suffer from higher somatic sensitivity and autonomic manifestations, 15 the specific neural mechanisms underlying these systemic and upper gastrointestinal complaints have not been extensively studied.…”

Section: Discussionmentioning

confidence: 99%

Cardiac autonomic regulation and joint hypermobility in adolescents with functional abdominal pain disorders

Kołacz

Kovacic

Lewis

et al. 2021

Neurogastroenterology Motil

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Background: Joint hypermobility (JH) is associated with autonomic nervous system dysregulation and functional abdominal pain disorders (FAPDs). Understanding the neurophysiological processes linking these conditions can inform clinical interventions. Autonomic activity regulates gastrointestinal (GI) sensorimotor function and may be a key mechanism. The aims of this study were to examine the relation of JH with dynamic autonomic activity and parasympathetic regulation in adolescents with FAPDs and identify optimal JH cutoff scores that best index autonomic regulation in FAPDs.Methods: A total of 92 adolescents with FAPDs and 27 healthy controls (age 8-18 years; 80% female) were prospectively enrolled. JH was assessed by Beighton scores. ECG recordings were conducted during supine, sitting, and standing posture challenges. ECG-derived variables-heart period (HP), respiratory sinus arrhythmia (RSA), and vagal efficiency (VE)-were analyzed using linear regression and mixed effects modeling.

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Functional gastrointestinal disorders are increased in joint hypermobility‐related disorders with concomitant postural orthostatic tachycardia syndrome

Abstract: This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Cited by 24 publications

References 26 publications

Overlap between irritable bowel syndrome and hypermobileEhlers–Danlossyndrome: An unexplored clinical phenotype?

Overlap between irritable bowel syndrome and hypermobileEhlers–Danlossyndrome: An unexplored clinical phenotype?

The challenges of chronic pain and fatigue

Cardiac autonomic regulation and joint hypermobility in adolescents with functional abdominal pain disorders

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