Joint Hypermobility Syndrome in Patients With Functional Dyspepsia

Florencia Carbone, Asma Fikree, Qasim Aziz, Jan Tack, Florencia Carbone, Asma Fikree, Qasim Aziz, Jan Tack

Abstract

Introduction: The pathophysiology underlying functional dyspepsia (FD) is multifactorial and focuses on gastric sensorimotor dysfunction. Recent studies demonstrated that joint hypermobility syndrome (JHS) is strongly associated with unexplained dyspeptic symptoms in patients attending gastrointestinal clinics. We aimed to study the relationship between symptoms, gastric sensorimotor function, and JHS in FD patients.

Methods: Tertiary care FD patients who underwent a gastric barostat study and a gastric emptying breath test with 13C-octanoic acid were recruited for assessment of JHS. The presence of JHS was evaluated by a 2-phase interview and clinical examination that included major and minor criteria of the Brighton classification.

Results: A total of 62 FD patients (68% women, age 44 ± 1.8 years, and body mass index: 21.7 ± 0.7 kg/m) accepted to participate in the study. JHS was diagnosed in 55% of FD patients. Assessed symptom profiles during the visit did not differ between the groups. Delayed gastric emptying was not significantly more common in JHS group compared with non-JHS group (JHS group 32% vs non-JHS group 16%, P = 0.31). Prevalence of hypersensitivity to distention (JHS group 24% vs non-JHS group 29%, P = 0.76) and impaired gastric accommodation (JHS group 38% vs non-JHS group 42%, P = 0.79) was similar in patients with or without JHS. No correlations were found between the Beighton hypermobility score and gastric compliance (r = 0.09).

Discussion: A large subset of this study cohort of tertiary care FD patients has coexisting JHS. We did not identify any specific differences in gastric sensorimotor function between patients with and without JHS. Further prospective research will be required to elucidate the relationship between JHS, a multisystemic disorder with widespread manifestations, and FD symptoms.

Conflict of interest statement

Guarantor of the article: Jan Tack, MD, PhD.

Specific author contributions: Jan Tack, MD, PhD, and Qasim Aziz, MD, PhD, share senior authorship for this work. J.T., F.C., Q.A., and A.F.: study concept and design. J.T., F.C., and A.F.: acquisition of data. J.T., F.C., and Q.A.: analysis and interpretation of data. J.T., F.C., Q.A., and A.F.: drafting of the manuscript and critical revision of the manuscript. J.T. takes responsibility for the integrity of the work as a whole, from inception to published article. All authors approved the final version of the manuscript.

Financial support: Funding was provided by a Methusalem grant from Leuven University to JT.

Potential competing interests: None to report.

Clinical trial registration number: S56776 (UZ Leuven number reference).

Figures

Figure 1.
Figure 1.
Gastric compliance of patients with functional dyspepsia with joint hypermobility syndrome (JHS) and without JHS. Representation of average intragastric balloon volume per increasing intragastric balloon pressure. No significant difference was observed in gastric compliance (slope volume/pressure) between groups (P = 0.60).
Figure 2.
Figure 2.
Gastric sensitivity to distention of patients with functional dyspepsia with joint hypermobility syndrome (JHS) and without JHS. Increasing gastric perception per increasing intragastric balloon pressure. Patients with JHS did not display a significantly different sensitivity to gastric distention compared with patients without JHS (P = 0.53).
Figure 3.
Figure 3.
Gastric accommodation in patients with functional dyspepsia with joint hypermobility syndrome (JHS) and without JHS. Time 0 is the time in which the patients drank a nutrient drink (200 mL, 300 kcal). No differences in gastric accommodation were observed between the groups (P = 0.78).

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