Undiagnosed joint hypermobility syndrome prevalent in GI clinics



Joint hypermobility syndrome is significantly associated with gastrointestinal symptoms, say researchers who found the undiagnosed condition in one-third of unselected patients attending a gastrointestinal clinic.

The prospective, cross-sectional cohort study enrolled 552 patients referred to gastrointestinal clinics from primary care and who were unaware of their hypermobility status, as well as a positive control group of 54 consecutive patients with diagnosed joint hypermobility syndrome (JHS) referred from specialist rheumatology clinics.

Researchers found that 180 (33%) of the 552 unselected patients attending the clinics had undiagnosed JHS, according to a paper published online in Clinical Gastroenterology and Hepatology.

"Although these JHS patients were previously undiagnosed, they had the same pattern of features as the JHS-Rh [rheumatology clinic–referred] patients, with increased musculoskeletal symptoms, autonomic symptoms, chronic widespread pain, and fibromyalgia, albeit to a lesser degree, suggesting they have a milder phenotype than JHS-Rh," wrote Dr. Asma Fikree of Queen Mary, University of London and her colleagues.

After adjustment for age and gender, the data showed that increasing JHS phenotype was associated with a significant increase in gastrointestinal symptoms.

"Although at first it would appear that JHS-Rh patients have a completely different set of GI symptoms than JHS-G [JH-positive, primary care–referred] patients, it becomes apparent when all three groups are compared that a whole range of symptoms previously deemed to be associated with JHS in tertiary non-GI settings, e.g., bloating, alternating bowel habit, dysphagia, and abdominal pain, show significantly increasing trends with increasing JHS phenotype," the authors wrote.

The patients with undiagnosed JHS presenting to the gastrointestinal clinics were significantly younger, and a higher proportion were female, compared with clinic attendees without JHS. The patients referred from rheumatology clinics were significantly younger than the patients in both these groups, and 95.5% were female.

The rheumatology clinic patients had a higher incidence of polyarthralgia, dislocations, soft tissue injuries, marfanoid habitus, skin changes, eye signs, varicose veins, and organ prolapse, compared with the primary care patients (Clin. Gastroenterol. Hepatol. 2014 [doi: 10.1016/j.cgh.2014.01.014]).

While gastrointestinal complaints are commonly found in inflammatory connective tissue disorders, the association between JHS and gastrointestinal symptoms was first documented in a 2003 study, which found 37% of JHS patients attending rheumatology clinics exhibited gastrointestinal symptoms such as nausea, abdominal pain, bloating, constipation, and diarrhea.

Researchers in this study used questionnaires to assess gastrointestinal symptoms, psychopathology, and autonomic symptoms, with the aim of identifying any particular gastrointestinal symptoms that might be associated with other known characteristics of JHS.

They found that only autonomic scores and the number of tender points affected the strength of the association between JHS and gastrointestinal symptoms, although the association with tender points was greater for the symptoms of heartburn and postprandial fullness.

There were no conflicts of interest declared.

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