Joint hypermobility: a common association with complex functional gastrointestinal disorders
Katja Kovacic1, Thomas C Chelimsky2, Manu R Sood1
1Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Center for Pediatric Neurogastroenterology, Motility, and Autonomic Disorders, Medical College of Wisconsin, Milwaukee, WI.
Insights
Joint hypermobility (JH) and related symptoms like fibromyalgia are common in pediatric functional gastrointestinal disorders (FGIDs). Screening for JH and comorbidities is recommended for these patients.
Area of Science:
- Gastroenterology
- Rheumatology
- Pediatrics
- Autonomic Medicine
Background:
- Functional gastrointestinal disorders (FGIDs) are common in children and young adults.
- Joint hypermobility (JH) and associated conditions are increasingly recognized in various pediatric populations.
- Tertiary care clinics manage complex cases, including those with neurogastroenterological and autonomic dysfunction.
Purpose of the Study:
- To determine the prevalence of joint hypermobility (JH) in pediatric patients presenting with functional gastrointestinal complaints.
- To identify comorbid conditions associated with JH in this patient group.
- To evaluate the incidence of postural tachycardia syndrome (POTS) and its relation to JH.
Main Methods:
- Retrospective chart review of 66 patients (aged 5-24 years) diagnosed with FGIDs.
- Assessment of joint hypermobility using Beighton or fibromyalgia tender point scores.
- Collection of comorbid symptoms and performance of autonomic testing for POTS.
Main Results:
- 56% of patients exhibited joint hypermobility (JH), significantly higher than in healthy populations.
- Postural tachycardia syndrome (POTS) was diagnosed in 34% of patients, with no significant correlation to JH.
- High rates of comorbid symptoms were observed, including sleep disturbances (77%), chronic fatigue (93%), dizziness (94%), migraines (94%), and fibromyalgia (24%).
Conclusions:
- Joint hypermobility (JH) and comorbid conditions like fibromyalgia are highly prevalent in children and young adults with complex functional gastrointestinal disorders (FGIDs).
- Postural tachycardia syndrome (POTS) is common in FGID patients but not directly linked to hypermobility.
- Screening for JH, fibromyalgia, and associated symptoms is advised for pediatric FGID patients.
Objective:
To evaluate the prevalence of joint hypermobility (JH) and comorbid conditions in children and young adults referred to a tertiary care neurogastroenterology and autonomic disorders clinic for functional gastrointestinal complaints.
Study Design:
This was a retrospective chart review of 66 new patients aged 5-24 years who fulfilled at least 1 pediatric Rome III criteria for a functional gastrointestinal disorder (FGID) and had a recorded Beighton score (n = 45) or fibromyalgia tender point score (n = 45) based on physician examination. Comorbid symptoms were collected and autonomic testing was performed for evaluation of postural tachycardia syndrome (POTS).
Results:
The median patient age was 15 years (range, 5-24 years), 48 (73%) were females, and 56% had JH, a significantly higher rate compared with population studies of healthy adolescents (P < .001; OR, 10.03; 95% CI, 5.26-19.13). POTS was diagnosed in 34% of patients and did not correlate significantly with hypermobility. Comorbid conditions were common, including sleep disturbances (77%), chronic fatigue (93%), dizziness (94%), migraines (94%), chronic nausea (93%), and fibromyalgia (24%).
Conclusion:
JH and other comorbid symptoms, including fibromyalgia, occur commonly in children and young adults with complex FGIDs. POTS is prevalent in FGIDs but is not associated with hypermobility. We recommend screening patients with complex FGIDs for JH, fibromyalgia, and comorbid symptoms such as sleep disturbances, migraines, and autonomic dysfunction.
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