Higher prevalence of joint hypermobility in constipation predominant irritable bowel syndrome

Zweig, Annina; Schindler, Valeria; Becker, Anton S.; Maren, A. van; Pohl, Daniel

doi:10.1111/nmo.13353

Cited by 23 publications

(21 citation statements)

References 34 publications

(42 reference statements)

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“…A HSD was demonstrated in patients with IBS-C and this was significantly higher than the prevalence in IBS-D (57.8% vs. 34.8%) (Zweig et al, 2018).…”

Section: Ibs Symptoms In Heds/hsdmentioning

confidence: 65%

“…hEDS and HSD have been heavily associated with IBS and a significant overlap between these disorders, particularly IBS-C, and hEDS/ HSD (Zweig, Schindler, Becker, van Maren, & Pohl, 2018) has repeatedly been documented in tertiary care Neurogastroenterology clinics (Zarate et al, 2010;Zweig et al, 2018), genetic clinics (Alomari et al, 2020;Castori et al, 2010;Nelson et al, 2015), secondary care GI clinics (Fikree et al, 2015), and patient support groups (Lam et al, 2021;Zeitoun et al, 2013).…”

Section: Ibs Symptoms In Heds/hsdmentioning

confidence: 99%

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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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“…A HSD was demonstrated in patients with IBS-C and this was significantly higher than the prevalence in IBS-D (57.8% vs. 34.8%) (Zweig et al, 2018).…”

Section: Ibs Symptoms In Heds/hsdmentioning

confidence: 65%

Section: Ibs Symptoms In Heds/hsdmentioning

confidence: 99%

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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“…These patients show increased somatisation score, urinary autonomic (symptom) score and reduced pain-related quality of life[ 66 ]. High rates of hypermobility are particularly observed in patients with constipation-predominant IBS[ 67 ], consistent with perturbation of colonic sensorimotor biomechanics consequent upon variant connective tissue.…”

Section: Resultsmentioning

confidence: 99%

Connecting brain and body: Transdiagnostic relevance of connective tissue variants to neuropsychiatric symptom expression

Sharp¹,

Critchley²,

Eccles³

2021

WJP

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The mind is embodied; thoughts and feelings interact with states of physiological arousal and physical integrity of the body. In this context, there is mounting evidence for an association between psychiatric presentations and the expression variant connective tissue, commonly recognised as joint hypermobility. Joint hypermobility is common, frequently under-recognised, significantly impacts quality of life, and can exist in isolation or as the hallmark of hypermobility spectrum disorders (encompassing joint hypermobility syndrome and hypermobile Ehlers-Danlos syndrome). In this narrative review, we appraise the current evidence linking psychiatric disorders across the lifespan, beginning with the relatively well-established connection with anxiety, to hypermobility. We next consider emerging associations with affective illnesses, eating disorders, alongside less well researched links with personality disorders, substance misuse and psychosis. We then review related findings relevant to neurodevelopmental disorders and stress-sensitive medical conditions. With growing understanding of mind-body interactions, we discuss potential aetiopathogenetic contributions of dysautonomia, aberrant interoceptive processing, immune dysregulation and proprioceptive impairments in the context of psychosocial stressors and genetic predisposition. We examine clinical implications of these evolving findings, calling for increased awareness amongst healthcare professionals of the transdiagnostic nature of hypermobility and related disorders. A role for early screening and detection of hypermobility in those presenting with mental health and somatic symptoms is further highlighted, with a view to facilitate preventative approaches alongside longer-term holistic management strategies. Finally, suggestions are offered for directions of future scientific exploration which may be key to further delineating fundamental mind-body-brain interactions.

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“…Musculoskeletal and neurologic exams can be useful to assess for possible contributing disease processes such as Ehlers-Danlos and Parkinson's disease, as constipation can be a presenting symptom in these conditions. 65 In cases such as IBS, the physical exam may be entirely normal, but distention may be missed, and conversely in those with distention, an exaggerated lumbar lordosis could be a red herring.…”

Section: Physical Exam With a Focus On The Digital Rectal Examinationmentioning

confidence: 99%

Clinical Evaluation of a Patient With Symptoms of Colonic or Anorectal Motility Disorders

Curtin

Jimenez

Rao

2020

J Neurogastroenterol Motil

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Constipation, irritable bowel syndrome, fecal incontinence, abdominal pain, and anorectal pain are problems that affect 40% of the population. They commonly present with overlapping symptoms indicating that their pathophysiology affects multiple segments of the gut as well as brain and gut interactions. Clinically, although some conditions are readily recognized, dyssynergic defecation, fecal incontinence, and anorectal pain are often missed or misdiagnosed. Consequently, the assessment of lower gastrointestinal symptoms in patients with suspected colonic or anorectal motility disorder(s) remains challenging for most clinicians. A detailed history, use of the Bristol stool form scale, prospective stool diaries, ideally through a phone App, digital rectal examination, and judicious use of complementary diagnostic tests are essential. Additionally, it is important to evaluate the impact of these problems on quality of life and psychosocial issues, because they are intricately linked with these disorders. The Rome IV diagnostic questionnaire for functional gastrointestinal disorders can provide additional information often missed during history taking. Here, we discuss a systematic approach for the clinical evaluation of patients with suspected lower gastrointestinal problems, grouped under 4 common diagnostic categories. We describe how to take a detailed history, perform meticulous digital rectal examination, and use validated tools to supplement clinical evaluation, including assessments of quality of life and scoring systems for disease severity and digital Apps. These tools could facilitate a comprehensive plan for clinical management including diagnostic tests, and translate the patients' complaints into definable, diagnostic categories.

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Higher prevalence of joint hypermobility in constipation predominant irritable bowel syndrome

Cited by 23 publications

References 34 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?

Connecting brain and body: Transdiagnostic relevance of connective tissue variants to neuropsychiatric symptom expression

Clinical Evaluation of a Patient With Symptoms of Colonic or Anorectal Motility Disorders

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