title: Functional gastrointestinal disorders are associated with the joint hypermobility syndrome in secondary care: a case-control study.
abstract: BACKGROUND
  The overlap of unexplained gastrointestinal (GI) and somatic symptoms is well established in patients with functional gastrointestinal disorders (FGID). Joint hypermobility syndrome (JHS) is a non-inflammatory connective tissue disorder associated with GI and somatic symptoms. We aimed to determine whether there is an association between diagnosis of JHS and FGID and the impact of this association on comorbidities and quality of life (QOL).
  
  
  METHODS
  Prospective case-control study in secondary care GI clinics over 2 years. JHS was assessed by the first author prior to consultation in 641 consecutive new patients. Diagnosis of FGID (cases, n = 336) or organic disorders (controls, n = 305) was established blind to JHS status. JHS prevalence was compared in cases (FGID patients) and controls (organic disorders patients). Extra-intestinal comorbidity and QOL were compared in FGID patients with and without JHS.
  
  
  RESULTS
  JHS prevalence was higher in FGID compared to organic GI disorders (39.0% vs 27.5%, ORadj: 1.51, CI: 1.07-2.12, p = 0.02), and particularly associated with functional gastroduodenal disorders (44.1%, ORadj: 2.08, CI: 1.25-3.46, p = 0.005), specifically postprandial distress syndrome (51%, ORadj: 1.99, CI: 1.06-3.76, p = 0.03). FGID patients with JHS had 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), and worse pain-related QOL scores (45.0 vs 63.5, p = 0.004).
  
  
  CONCLUSIONS
  JHS is significantly associated with FGID, and this subgroup of patients have increased comorbidity and decreased QOL. Further research is required to understand the pathophysiological basis of this association.
authors: Wingate Institute of Neurogastroenterology, Centre for Digestive Diseases, Blizard Institute of Cell and Molecular Science, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
authors: A
authors: A
authors: Fikree
authors: R
authors: R
authors: Aktar
authors: R
authors: R
authors: Grahame
authors: A J
authors: AJ
authors: Hakim
authors: J K
authors: JK
authors: Morris
authors: C H
authors: CH
authors: Knowles
authors: Q
authors: Q
authors: Aziz
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D015897:Comorbidity; D005260:Female; D005767:Gastrointestinal Diseases / Q000175:diagnosis / Q000453:epidemiology*; D006801:Humans; D007593:Joint Instability / Q000175:diagnosis / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D011788:Quality of Life
keywords: Ehlers-Danlos syndrome; fibromyalgia; functional dyspepsia; gastro-esophageal reflux disease; irritable bowel syndrome; joint hypermobility