title: Gastrointestinal and nutritional issues in joint hypermobility syndrome/Ehlers-Danlos syndrome, hypermobility type.
abstract: Gastrointestinal involvement is a well known complication of Ehlers-Danlos syndromes (EDSs), mainly in form of abdominal emergencies due to intestinal/abdominal vessels rupture in vascular EDS. In the last decade, a growing number of works investigated the relationship between a wide spectrum of chronic gastrointestinal complaints and various EDS forms, among which the hypermobility type (a.k.a. joint hypermobility syndrome; JHS/EDS-HT) was the most studied. The emerging findings depict a major role for gastrointestinal involvement in the health status and, consequently, management of JHS/EDS-HT patients. Nevertheless, fragmentation of knowledge limits its impact on practice within the boundaries of highly specialized clinics. In this paper, literature review on gastrointestinal manifestations in JHS/EDS-HT was carried out and identified papers categorized as (i) case-control/cohort studies associating (apparently non-syndromic) joint hypermobility and gastrointestinal involvement, (ii) case-control/cohort studies associating JHS/EDS-HT and gastrointestinal involvement, (iii) case reports/series on various gastrointestinal complications in (presumed) JHS/EDS-HT, and (iv) studies reporting gastrointestinal features in heterogeneous EDS patients' cohorts. Gastrointestinal manifestations of JHS/EDS-HT were organized and discussed in two categories, including structural anomalies (i.e., abdominal/diaphragmatic hernias, internal organ/pelvic prolapses, intestinal intussusceptions) and functional features (i.e., dysphagia, gastro-esophageal reflux, dyspepsia, recurrent abdominal pain, constipation/diarrhea), with emphasis on practice and future implications. In the second part of this paper, a summary of possible nutritional interventions in JHS/EDS-HT was presented. Supplementation strategies were borrowed from data available for general population with minor modifications in the light of recent discoveries in the pathogenesis of selected JHS/EDS-HT features.
authors.forename: Marco
authors.initials: M
authors.lastname: Castori
authors.forename: Silvia
authors.initials: S
authors.lastname: Morlino
authors.forename: Giulia
authors.initials: G
authors.lastname: Pascolini
authors.forename: Carlo
authors.initials: C
authors.lastname: Blundo
authors.forename: Paola
authors.initials: P
authors.lastname: Grammatico
mesh_terms: D016022:Case-Control Studies; D004535:Ehlers-Danlos Syndrome / Q000150:complications* / Q000503:physiopathology; D005767:Gastrointestinal Diseases / Q000150:complications / Q000503:physiopathology*; D006801:Humans; D007593:Joint Instability / Q000150:complications / Q000151:congenital* / Q000503:physiopathology
keywords: Ehlers-Danlos syndrome; abdominal pain; constipation; diet; nutraceuticals