A Prospective Evaluation of Undiagnosed Joint Hypermobility Syndrome in Patients With Gastrointestinal Symptoms.
Clin Gastroenterol Hepatol. 2014 Jan 15;
Authors: Fikree A, Grahame R, Aktar R, Farmer AD, Hakim AJ, Morris JK, Knowles CH, Aziz Q
BACKGROUND: The Joint Hypermobility Syndrome (JHS) is a common connective tissue disorder characterised by joint hyperflexibility, dysautonomia and chronic pain. Gastrointestinal (GI) symptoms are reported in JHS patients attending rheumatology clinics but the prevalence and symptom pattern of previously undiagnosed JHS in GI clinics is unknown.
METHODS: Using validated questionnaires, a prospective cross-sectional study in secondary care GI clinics estimated the prevalence of JHS in new consecutively referred patients, compared GI symptoms in patients with and without JHS, and using multiple regression determined whether the burden of GI symptoms in JHS patients was dependent on chronic pain, autonomic, psychological and medication related factors. A positive control group consisted of JHS patients referred from rheumatology clinics with GI symptoms (JHS-Rh).
RESULTS: From 552 patients recruited, 180 (33%) had JHS (JHS-G) and 372 did not (Non-JHS-G). 44 JHS-Rh patients were included. JHS-G patients were more likely to be younger, female with poorer quality of life (p=0.02) than non-JHS-G patients. Following age and sex matching, heartburn (OR1.66, CI 1.1-2.5 p=0.01), waterbrash (OR: 2.02, CI: 1.3-3.1, p=0.001) and postprandial fullness (OR 1.74, CI 1.2-2.6 p=0.006) were commoner in JHS-G vs. Non-JHS-G. Many upper and lower GI symptoms increased with increasing severity of JHS phenotype. Upper GI symptoms were dependent on autonomic and chronic pain factors.
CONCLUSIONS: JHS is common in GI clinics, with increased burden of upper GI and extraintestinal symptoms and poorer quality of life. Recognition of JHS will facilitate multidisciplinary management of GI and extra-GI manifestations.
PMID: 24440216 [PubMed - as supplied by publisher]