Original articleAlimentary tractA Prospective Evaluation of Undiagnosed Joint Hypermobility Syndrome in Patients With Gastrointestinal Symptoms
Section snippets
Objectives and Hypotheses
Our aims were to determine (1) the prevalence and phenotypic severity of JHS in GI clinics; (2) whether in this setting, JHS is associated with a particular or excessive GI symptom burden and reduced quality of life (QOL) compared with patients without JHS; and (3) whether GI symptoms in JHS are interdependent with other patient characteristics previously associated with JHS (autonomic dysfunction, chronic pain, somatization, and psychopathology).
Study Design, Cohort Selection, and Setting
A prospective cross-sectional study design was used to address our aims.
The main study cohort was derived from consecutive new patients with GI symptoms (but without prior JHS diagnosis), aged 16–70 years, who were attending general gastroenterology clinics at a large university teaching hospital in London between April 2010 and April 2012. After hypermobility assessment, patients were categorized as JHS (JHS-G) or non-JHS (non-JHS-G). An additional smaller sample of consecutive new patients
Unselected cohort
Two thousand four hundred one new patients referred from primary care to GI clinics and unaware of their hypermobility status were invited to participate, and 723 consented to take part. Of these, 144 did not complete their questionnaires, 16 did not undergo a full examination, and 11 did not meet the inclusion criteria, leaving 552 patients who were included in the study (Figure 1).
Positive control group
Fifty-four consecutive patients referred from specialist rheumatology clinics with a known diagnosis of JHS
Discussion
This is a comparative study of GI symptoms in patients with and without JHS in a prospective unselected (unbiased) cohort attending secondary care GI clinics. The main findings were (1) approximately one-third of unselected patients attending GI clinics have undiagnosed JHS based on validated clinical criteria; however, the phenotype is less severe than that observed in selected patients from rheumatology clinics; (2) undiagnosed JHS is significantly associated with increased reflux and
Conclusion
JHS is common and present in approximately one-third of patients attending GI clinics, albeit of a less marked phenotype than JHS-Rh in terms of hypermobility features, autonomic symptoms, chronic pain measures, and GI symptoms. Dyspepsia and reflux are significantly increased in these patients, and the mechanism for these symptoms remains to be elucidated, although it would seem that autonomic and pain/hypersensitivity factors are involved. Although future studies will examine the specific
Acknowledgments
The authors thank Dr Hanadi Kazkaz, MBBS, University College Hospital London, for assistance with the rheumatological aspects of the study; and Dr Neel Sharma, MBBS, for assistance with the collection of part of the data. They also thank Professor David Alpers (Centre for Human Nutrition) and Professor David Rampton (Queen Mary University London) for critical appraisal of the manuscript.
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Conflicts of interest The authors disclose no conflicts.
Funding Supported by a charitable grant from the Pseudo-obstruction Research Trust, as well as a grant from Bowel and Cancer Research and Ehlers-Danlos Syndrome Support UK.