Skip to main content
. 2022 Jul 20;37(9):1693–1709. doi: 10.1111/jgh.15927

Table 3.

Overview of the key findings generated from studies based on patients attending gastroenterology clinics

Author Study type, clinic setting Patient cohort Assessment Key findings
Mohammed, et al., 2010 50 Retrospective cohort Gastroenterology clinic Intractable constipation and rectal evacuatory dysfunction: n = 200 (joint hypermobile n = 65; 179 female, median age 53 years)

  • Questionnaires: 5PQ, Rome III questionnaire for IBS, comprehensive bowel symptom questionnaire including constipation score and fecal incontinence score

  • Anorectal physiology studies
Cases vs controls:
  • Joint hypermobility: 33% (65/200) vs 14% (P = 0.0005)
  • Pelvic organ prolapse with or without surgical repair: 31% (20/65) vs 17% (23/135) (P = 0.04)
Hypermobile vs non‐hypermobile group:
  • Abdominal pain: 75% vs 53% (P = 0.003)
  • Use of digital rectal evacuation: 69% vs 50% (P = 0.009)
  • Laxative use: 55% vs 37% (P = 0.03)
  • Reduced squeeze increment pressures: 32% vs 19% (P = 0.05)
  • Incomplete rectal evacuation: 80% vs 59% (P = 0.004)
  • Anorectal anatomical abnormalities: 86% vs 64% (P = 0.001) including large functional rectocele (28% vs 14%, P = 0.03); extrinsic compression of anterior rectal wall (11% vs 1%, P = 0.006); incomplete rectal evacuation: 80% vs 59% (P = 0.004)
Zarate et al., 2010 26 Retrospective neuro‐gastroenterology clinic 129 consecutive newly referred patients stratified by joint hypermobility status; subset of 21 patients confirmed with HSD/hEDS

  • Symptom assessment

  • Joint hypermobility

 49% (63/129) had generalized joint hypermobility:

  • Symptoms: abdominal pain (81%), bloating (57%), nausea (57%), reflux symptoms (48%), vomiting (43%), diarrhea (14%)

  • Compared with non‐hypermobile patients: younger; more often female; more likely to have bloating (62% vs 46%, P = 0.05), reflux symptoms (56% vs 30%, P = 0.005), unexplained gastrointestinal symptoms (81% vs 41%, P < 0.0001)
Fikree et al., 2014 4

Prospective cross‐sectional

General gastroenterology clinic

Consecutive new referrals (16–70 years) stratified by HSD/hEDS status (Brighton criteria) (Total n = 552; HSD/hEDS = 372

Non‐HSD/hEDS: n = 80

HSD/hEDS patients referred from rheumatology clinic (positive control): n = 44

  • Questionnaires: gut symptoms (bowel disease questionnaire); psychopathology (SCL‐90); autonomic symptoms (COMPASS): quality of life (SF‐36)

  • Examination

  • Structured interview
Undiagnosed HSD/hEDS 33% (n = 180/552):
  • younger (41 years vs 44 years, P = 0.003);
  • more likely to be female (68% vs 55%, P = 0.002)
  • greater prevalence of heartburn (aOR 1.66, CI 1.1–2.5); waterbrash (aOR 2.02, CI 1.3–3.1); postprandial fullness (aOR 1.74, CI 1.2–2.6) adjusting for age and sex
Non‐HSD/hEDS vs new HSD/hEDS vs previously diagnosed HSD/hEDS:
  • DGBI prevalence: 48% vs 58% vs 91% (P < 0.001)
  • Organic disorders: 44% vs 31% 8% (P < 0.001)
  • Autonomic symptom scores: urinary (0 vs 10 vs 30 (P < 0.001); orthostatic intolerance (25 vs 31.25 vs 68.75, (P < 0.001); vasomotor (0 vs 0 vs 56.7 (P < 0.001)
Fikree et al., 2015 22

Prospective case–control (functional and organic diagnosis)

Secondary gastroenterology clinic

 Consecutive referrals of patients with gastrointestinal symptoms, no prior HSD/hEDS diagnosis Total n = 641 (Organic disease controls n = 306 vs DBI cases n = 336; 378 female; mean age 42 years)

  • Questionnaires: bowel disease questionnaire, pscyhopathology SCL‐90; autonomic symptoms (COMPASS), somatic symptoms (PHQ‐15) and quality of life (SF‐36);

  • Structured interview and examination for HSD/hEDS (Brighton criteria) and fibromyalgia (1990 Wolfe criteria)
DGBI vs organic disease controls:
  • Female: 66% vs 52% (P < 0.001)
  • Mean age: 40 vs 44 years (P = 0.001)
  • HSD/hEDS prevalence: 39% vs 28% (P = 0.002)
Adjusted OR (age, gender) for HSD/hEDS:
  • Functional gastroduodenal disorders (2.08, CI 1.25–3.46, P = 0.005);
  • Postprandial distress syndrome (1.99 CI 1.0–3.76, P = 0.03)
  • No association with lower gastrointestinal symptoms, including IBS
DGBI‐HSD/hEDS vs non‐HSD/EDS:
  • Chronic pain: 23.2 vs 11.9 (P = 0.02),
  • Fibromyalgia: 10.5 vs 3.1 (P = 0.01),
    Somatic sensitivity: PHQ15 score 13 vs 10 (P < 0.001)
  • Anxiety: 0.5 vs 0.3 (P = 0.01);
  • Poorer quality of life scores (in domains of role‐limiting emotional and pain)
Fikree et al., 2017 43

Retrospective, observational

Neuro‐gastroenterology clinic

Consecutive HSD/hEDS patients referred to gastrointestinal physiology unit for assessment of reflux or dysphagia

HSD/hEDS: n = 30 (28 female; median age 30 years)—further stratified by PoTS status;

non‐HSD/hEDS dysphagia: n = 98 (56 female)

Reflux controls: n = 108 (61 female)

  • Questionnaires: reflux disease questionnaire, hospital odynophagia dysphagia questionnaire, Hospital Anxiety and Depression Scale (HADS)

  • Medical and medication history

  • High resolution manometry or multichannel intraluminal impedance testing
HSD/hEDS vs non‐HSD/hEDS:
  • Reflux hypersensitivity (21% vs 5%, P = 0.01).
  • Esophageal hypomotility 40% in HSD/hEDS vs 23% in (P = 0.09).
PoTS vs non‐PoTS‐HSD/hEDS:
  • Reflux scores: 24.5 vs 16.5 (P = 0.05)
  • Dysphagia scores: 21 vs 11.5 (P = 0.04)
Menys et al., 2017 54

Pilot feasibility

Tertiary neuro‐gastroenterology clinic

HSD/hEDS with Postprandial distress (Rome III): n = 9

Healthy controls: n = 9

  • MRI at baseline following cessation of motility‐influencing medication

  • Gastric emptying time, motility and accommodation and duodenal distension and motility assessed following ingestion of water.

 HSD/hEDS vs control:

  • Similar gastric emptying time: 12.5 vs 20 min (P = 0.15).

  • Lower mean increase in gastric motility: 11% vs 22% (P = 0.03).

  • Similar gastric accommodation: 56% vs 67% (P = 0.19)
Zweig et al., 2018 30 Retrospective review of prospectively collected data at neuro‐gastroenterology clinic 228 IBS (Rome III) patients (67% female); stratified by joint hypermobility status

  • Rome III criteria

  • Beighton score and Brighton criteria

  • Psychological assessment: visceral sensitivity index; Hospital and Anxiety Depression Scale

 Joint hypermobility

  • More common in female vs male: 83 (55%) vs 12 (16%) P < 0.001

  • Significantly higher in IBS‐C compared with IBS‐D (58% vs 35%, P = 0.008)

  • IBS patients reported significantly more concomitant postprandial distress: 72% vs 49%, P = 0.007

  • Similar visceral sensitivity index 38 vs 37, P = 0.720

  • No significant association between HSD/hEDS and IBS subtypes
Carbone et al., 2021 55

Prospective case–control

University hospital clinic

Functional dyspepsia (Rome III): n = 39 stratified by HSD/hEDS status using Brighton classification

Healthy controls: n = 15

  • Questionnaire: dyspepsia symptom severity score; visual analogue scale

  • Blinded nutrient drink infusion via nasogastric tube at 60 ml/min until satiation or symptoms

  • Intragastric pressure measured by high resolution manometry
HSD/hEDS vs controls
  • Functional dyspepsia: 56% vs 7% (P = 0.002)
  • No differences in symptom pattern
Carbone, et al. 2022 61

Retrospective recruitment, prospective evaluation of joint hypermobility

Gastroenterology clinic

62 patients with preexisting functional dyspepsia

n = 62 (68% female, age 44 years, BMI 22 kg/m2)

  • Interview and examination for HSD/hEDS status (Brighton criteria)

  • Historic results for gastric emptying (using 13C breath test); gastric barostat assessment

55% HSD/hEDS criteria met vs 39% no joint disease/syndrome vs 6% “other” joint disorder

HSD/hEDS vs non‐HSD/hEDS
  • Female: 74% vs 63% (P = 0.02)
  • Similar symptomatology: postprandial fullness (76% vs 82%); bloating (73% vs 77%); early satiety (58% vs 41%); nausea (42% vs 36%); belching (42% vs 36%); reflux (21% vs 5%)
  • Similar rates of delayed gastric emptying (32% vs 16%, P = 0.31)
  • No differences in gastric compliance, minimal distention pressure and meal‐induced proximal stomach relaxation