The Digestive system and EDS-H / JHS

Ehlers-Danlos Syndrome Hypermobile Type / Joint Hypermobility Syndrome can cause symptoms that affect your digestive (gastrointestinal) system.

The outer layer of the digestive tract is made from connective tissue, yet little is known about its role in disorders affecting this area of the body. Whilst many practitioners are aware of the gastrointestinal symptoms and dysfunction caused by inflammation of the connective tissue, few are aware of the role of non‐inflammatory connective tissue abnormalities in causing gastrointestinal symptoms and dysfunction and more research needs to be carried out in this area.Joint hypermobility syndrome and Ehlers Danlos Syndrome Hypermobility Type – are relatively common non‐inflammatory connective disorders, so it perhaps unsurprising that preliminary studies suggest that many individuals with these conditions also experience problems with the digestive system and have abnormalities in its anatomy and physiology. It seems that the prevalence of JHS / EDS-H is higher than expected in patients with functional gastrointestinal disorders such as Irritable Bowel Syndrome, suggesting that patients with these connective tissue disorders may be predisposed to developing GI dysfunction. In a preliminary retrospective study, of people who had been referred for neurogastroenterology care for unexplained GI symptoms, a high incidence of joint hypermobility was found (63 of the 97 female patients tested). Of these 63 patients, 25 were randomly picked and asked to undergo clinical assessment for Joint Hypermobility Syndrome. The rheumatologist confirmed the clinical impression of Joint Hypermobility Syndrome in 23 of these 25. Professor Qasim Aziz MA, FRCP Professor of Neurogastroenterology, states: ‘We are now aware that a significant proportion of patients that present to our tertiary care neurogastroenterology clinic, with unexplained gastrointestinal symptoms, who are traditionally diagnosed as having Functional Gastrointestinal Disorder (i.e. unexplained gastro symptoms), have evidence of joint hypermobility.’

 ‘A series of muscles squeeze food through your digestive system. In EDS-H / JHS, these muscles may be weaker than they should be and this leads to food progressing more slowly though your digestive system. This can cause a range of symptoms including:

  • Heartburn – stomach acid leaking from your stomach into your gullet

  • Constipation – having to strain more than usual, or an inability to pass faeces as often as you usually would

  • Irritable bowel syndrome – a disorder that causes tummy pain, diarrhea and constipation’Gastroparesis – the stomach has difficulty emptying its contents into the small bowel, which can cause nausea, vomiting and bloating

  • Bacterial Overgrowth in the bowel, which may cause diarrhea, bloating and cramps

‘Tears of the tissues connecting abdominal wall muscles are another very common problem among people with hypermobility. The muscles themselves do not tear, rather the fibres connecting different muscles do, creating a gap between two muscles. Small segments of intestine can occasionally push up through these gaps, causing pain. As pressure backs up behind this “stuck” segment, pain gets worse and is felt in a larger area, but eventually resolves when the intestine that has pushed up into the layer of muscle falls back into place. The timing of the pain is quite random, depending only on the movement of bowel contents and the contractions of the intestines. The lack of any correlation to meals or bowel movements is one clue to the cause of the pain.

Unfortunately, these abdominal wall “defects” usually will not be found on a cursory physical exam, nor on x-rays, CT scans, or sonograms, and most physicians think they are rare and so do not look for them. Depending on where the defects are located, patients may be incorrectly diagnosed with reflux, ulcer, gallstones, ovarian cysts, diverticulitis, and most often, irritable bowel syndrome. Once patients understand the source of the pain, most can tolerate it, or find ways, such as changing position, to relieve it. Surgical repair is rarely necessary, except when true hernias occur, i.e. when intestine pushes through the abdominal wall muscles and stays there. The most important reasons to make this diagnosis are to prevent unnecessary testing and treatments for other incorrect diagnoses, and to reassure patients that they don’t have something terribly wrong that hasn’t shown up in the tests they’ve already had.’   Quote: Dr. Alan Pocinki MD)

‘We are now aware that a significant proportion of patients that present to our tertiary care neurogastroenterology clinic, with unexplained gastrointestinal symptoms, who are traditionally diagnosed as having Functional Gastrointestinal Disorder (i.e. unexplained gastro symptoms), have evidence of joint hypermobility.’

(Quote Professor Qasim Aziz MA, FRCP Professor of Neurogastroenterology, Director of Wingate Institute of Neurogastroenterology, Barts and The London School of Medicine and Dentistry, Queen Mary University of London)

 Howard P Levy, MD, PhD, Department of Medicine, Division of General Internal Medicine) suggests:

Gastritis and reflux symptoms may require intensive therapy. Other treatable causes, such as

H. pylori infection, should be investigated. Upper endoscopy is indicated for resistant symptoms, but frequently is normal other than chronic gastritis.

Delayed gastric emptying should be identified if present and treated as usual with promotility agents.

Irritable bowel syndrome is treated as usual with antispasmodics, antidiarrheals, and laxatives as needed. A motility enhancer  may be helpful for those with constipation only. Tricyclic antidepressants may be especially helpful for persons with both neuropathic pain and diarrhea.

  by edhs.info

 

Gastrointestinal complications of the Ehlers-Danlos syndrome

Peter H. Beighton, J. Lamont Murdoch and Theodore Votteler

Gut 1969 10: 1004-1008

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