In patients with unexplained abdominal problems referred to a tertiary centre, half had evidence of joint hypermobility syndrome (JHS).
Though Hypermobility is noted for its relation to Fibromyalgia, it appears abdominal problems are even more likely – something that would validate the symptoms in many patients. There is now an association with constipation as well.
The relation with abdominal symptoms was published here:
Neurogastroenterol Motil (2010) 22, 252–e78
Unexplained gastrointestinal symptoms and joint hypermobility: is connective tissue the missing link?
N. ZARATE,1,* A. D. FARMER,1,* R. GRAHAME, S. D. MOHAMMED,* C. H. KNOWLES,* S. M. SCOTT* & Q. AZIZ abstract here
- 129 cases – 97 females – referred to a neurogastroenterology clinic
- Use Modified Brighton for delineating hypermobility:
- (see separately to print -make sure enlarge first – here)
What difference they did find was JHS subjects were
- JHS bit younger 37 versus 44 (p=0.01),
- more likely female – 86% versus 65% (P<0.001),
- more likely to have reflux symptoms (heartburn, waterbrash or regurgitation): 56% versus 30%
A typical case would be:
- A 25-year-old woman with unexplained multiple GI symptoms
- dysphagia (trouble swallowing)to solids since childhood
- severe reflux,
- postprandial abdominal pain,
- severe constipation.
- Worsening symptoms as teenager- severely limited her food intake resulting in 12 kg weight loss, thought anorexia nervosa though denied
- chronic joint pains especially wrists and knees.
- features suggestive of JHM.
The link with constipation was just published:
Neurogastroenterol Motil. 2010 Oct;22(10):1085-e283.
Joint hypermobility and rectal evacuatory dysfunction: an etiological link in
abnormal connective tissue?
Mohammed SD, Lunniss PJ, Zarate N, Farmer AD, Grahame R, Aziz Q, Scott SM.
- Constipation scores worse than those with JHS
- Rectal evacuatory dysfunction (RED) – represents a problem with a rectocele – out-pouching of rectum in vagina – this leads to “ineffective propulsive force”
- Symptoms would include:
- need for manual assistance (finger in rectum or vagina to help push out contents)
- abdominal pain
- use of laxatives
- incomplete evacuation
- significant rectocele
Comments – Unexplained abdominal pains and constipation might suddenly become explainable is one looks for Hypermobility issues. The idea that just because a cause is not immediately identifiable means it’s psychosomatically psychological is such tripe.
There is an association of Ehlers–Danlos syndrome and bladder diverticulum causing bladder obstruction:
Clinical and Experimental Dermatology Volume 23, Issue 3, pages 109–112, May 1998
Giant bladder diverticulum in Ehlers–Danlos syndrome type I causing outflow obstruction
BURROWS1,4, MONK2, HARRISON4, POPE1 abstract here
This was confirmed in a recent study:
Neurogastroenterol Motil. 2015 Apr;27(4):569-79. doi: 10.1111/nmo.12535.
Functional gastrointestinal disorders are associated with the joint hypermobility
syndrome in secondary care: a case-control study.
Fikree A(1), Aktar R, Grahame R, Hakim AJ, Morris JK, Knowles CH, Aziz Q.
- postprandial distress syndrome (51%, ORadj: 1.99, CI: 1.06-3.76, p = 0.03).
- increased chronic pain (23.2% vs 11.9%, p = 0.01)
- fibromyalgia (10.5% vs 3.1%, p = 0.01),
- somatization scores (13 vs 10, p < 0.001),
- urinary autonomic scores (30.5 vs 20.7, p = 0.03),
- worse pain-related QOL scores (45.0 vs 63.5, p = 0.004).
One wonders if hypermobility will be associated with premature Bowel diverticular disease as well… I have couple patients with hereditary interstitial cystitis and hypermobility so increased “autonomic scores” are interesting.