The association between Ehlers-Danlos syndrome-hypermobility type and gastrointestinal symptoms in university students: a cross-sectional study

Neurogastroenterol Motil. 2017 Mar;29(3). doi: 10.1111/nmo.12942. Epub 2016 Sep 28.


Background: Patients with Ehlers-Danlos syndrome-hypermobility type (EDS-HT) have increased prevalence of gastrointestinal (GI) symptoms, particularly reflux and dyspepsia. EDS-HT is associated with dysautonomia, psychopathology, and chronic pain which can be associated with GI symptoms. The association between GI symptoms and EDS-HT in a 'non-patient' population and the effect of the above-mentioned factors has never been studied.

Methods: In a cross sectional study, a hypermobility questionnaire was used to screen university students; further clinical examination established the diagnosis of EDS-HT. Validated questionnaires assessed for GI, somatic, pain and autonomic symptoms, psychopathology and quality of life (QOL). These were compared in students with and without EDS-HT; logistic regression analysis examined associations between EDS-HT, GI symptoms and other variables.

Key results: Of 1998 students screened, 162 were included: 74 EDS-HT (21.0 years, 53% female) vs 88 Non-EDS-HT (21.5 years, 65% female). Compared to non-EDS-HT students, EDS-HT students were more likely to have multiple GI symptoms (41.9% vs 27.3% P=.05), particularly postprandial fullness (34.4% vs 15.9%, P=.01) and early satiety (32% vs 17%, P=.03), greater autonomic (P<.001) and somatic symptoms (P=.04) but not psychopathology (P>.8). The association between EDS-HT and postprandial symptoms was dependent on autonomic factors but independent of pain and psychopathology. Pain-related QOL scores were reduced in the EDS-HT group (80 vs 90, P=.03).

Conclusions and inferences: The previously described association between EDS-HT, dyspepsia, pain and autonomic symptoms in patients is also present in non-patient groups. Future studies are necessary to explore the etiological role of connective tissue in GI and extra intestinal symptoms.

Keywords: autonomic; fibromyalgia; functional dyspepsia; functional gastrointestinal disorders; hypermobility.

MeSH terms

  • Adolescent
  • Adult
  • Cross-Sectional Studies
  • Double-Blind Method
  • Ehlers-Danlos Syndrome / diagnosis
  • Ehlers-Danlos Syndrome / epidemiology*
  • Ehlers-Danlos Syndrome / psychology
  • Female
  • Gastrointestinal Diseases / diagnosis
  • Gastrointestinal Diseases / epidemiology*
  • Gastrointestinal Diseases / psychology
  • Humans
  • Joint Instability / diagnosis
  • Joint Instability / epidemiology*
  • Joint Instability / psychology
  • Male
  • Students* / psychology
  • Surveys and Questionnaires
  • Universities*
  • Young Adult