Mechanisms underlying reflux symptoms and dysphagia in patients with joint hypermobility syndrome, with and without postural tachycardia syndrome. Issue 6 (12th February 2017)

• Record Type: Journal Article
• Authors: Fikree, A.; Aziz, Q.; Sifrim, D.
• Is Part Of: Neurogastroenterology & motility. Volume 29:Issue 6(2017)
• Page Start: n/a
• Page End: n/a
• Publication Date: 2017-02-12
• Subjects: dysmotility -- Ehlers‐Danlos syndrome -- functional gastrointestinal disorder -- high‐resolution manometry -- postural tachycardia syndrome; Gastrointestinal system -- Motility -- Periodicals; Gastrointestinal system -- Innervation -- Periodicals; 616.33
• DOI: 10.1111/nmo.13029
• Languages: English
• ISSNs: 1350-1925

Abstract

Abstract: Background: The joint hypermobility syndrome (JHS) is a common non‐inflammatory connective tissue disorder which frequently co‐exists with postural tachycardia syndrome (PoTS), a form of orthostatic intolerance. Gastrointestinal symptoms and dysmotility have been reported in PoTS. Dysphagia and reflux are common symptoms in JHS, yet no studies have examined the physiological mechanism for these, subdivided by PoTS status. Methods: Thirty patients (28 female, ages: 18‐62) with JHS and symptoms of reflux (n=28) ± dysphagia (n=25), underwent high‐resolution manometry and 24 hour pH‐impedance monitoring after questionnaire‐based symptom assessment. Esophageal physiology parameters were examined in JHS, subdivided by PoTS status. Results: Fifty‐three percent of JHS patients with reflux symptoms had pathological acid reflux, 21% had reflux hypersensitivity, and 25% had functional heartburn. Acid exposure was more likely to be increased in the recumbent than upright position (64% vs 43%). The prevalence of hypotensive lower esophageal sphincter (33%) and hiatus hernia (33%) was low. Forty percent of patients with dysphagia had minor disorders of motility, 60% had functional dysphagia. Eighteen (60%) patients had coexistent PoTS—they had significantly higher dysphagia (21 vs 11.5, P =.04) and reflux scores (24.5 vs 16.5, P =.05), and double the prevalence of pathological acid reflux (64% vs 36%, P =.1) and esophageal dysmotility (50% vs 25%, P =.2) though this was not significant. Conclusions and Inferences: A large proportion of JHS patients with esophageal symptoms have true reflux‐related symptoms or mild esophageal hypomotility, and this is more likely if they have PoTS. Abstract : No studies have examined the physiological abnormalities associated with esophageal symptoms in patients with JHS, divided by PoTS status. The majority of JHS patients with reflux symptoms have true pathological reflux and those with dysphagia have a high prevalence of mild esophageal hypomotility. These abnormalities are more striking in the subgroup of patents with PoTS.