Cardiac autonomic regulation and joint hypermobility in adolescents with functional abdominal pain disorders. Issue 12 (15th May 2021)

• Record Type: Journal Article
• Authors: Kolacz, Jacek; Kovacic, Katja; Lewis, Gregory F.; Sood, Manu R.; Aziz, Qasim; Roath, Olivia R.; Porges, Stephen W.
• Is Part Of: Neurogastroenterology & motility. Volume 33:Issue 12(2021)
• Page Start: n/a
• Page End: n/a
• Publication Date: 2021-05-15
• Subjects: autonomic nervous system -- functional gastrointestinal disorders -- joint hypermobility -- Polyvagal theory -- vagal efficiency; Gastrointestinal system -- Motility -- Periodicals; Gastrointestinal system -- Innervation -- Periodicals; 616.33
• DOI: 10.1111/nmo.14165
• Languages: English
• ISSNs: 1350-1925

Abstract

Abstract: Background: Joint hypermobility (JH) is associated with autonomic nervous system dysregulation and functional abdominal pain disorders (FAPDs). Understanding the neurophysiological processes linking these conditions can inform clinical interventions. Autonomic activity regulates gastrointestinal (GI) sensorimotor function and may be a key mechanism. The aims of this study were to examine the relation of JH with dynamic autonomic activity and parasympathetic regulation in adolescents with FAPDs and identify optimal JH cutoff scores that best index autonomic regulation in FAPDs. Methods: A total of 92 adolescents with FAPDs and 27 healthy controls (age 8–18 years; 80% female) were prospectively enrolled. JH was assessed by Beighton scores. ECG recordings were conducted during supine, sitting, and standing posture challenges. ECG‐derived variables—heart period (HP), respiratory sinus arrhythmia (RSA), and vagal efficiency (VE)—were analyzed using linear regression and mixed effects modeling. Key Results: Beighton scores of ≥4 optimally distinguished autonomic function. Adolescents with FAPD and JH had reduced VE compared to adolescents with FAPDs without JH ( B = 18.88, SE = 6.25, p = 0.003) and healthy controls ( B = 17.56, SE = 8.63, p = 0.044). These subjects also had lower and less dynamic RSA and HP values during posture shifts, with strongest differences in supine position and using the VE metric. Conclusions & Inferences: Suboptimal autonomic regulation indexed by reduced vagal efficiency may be a mechanism of symptoms in hypermobile FAPD patients with Beighton score ≥ 4. Autonomic disturbance may serve as potential intervention target for patients with JH and functional GI disorders. Abstract : A novel, scalable measure of dynamic vagal efficiency shows that adolescents with functional abdominal pain disorders (FAPDs) and joint hypermobility (JH) have compromised autonomic regulation compared to those with FAPDs only and healthy controls.