|dc.description.abstract||Despite the fact that functional gastrointestinal disorders (FGID), such as
irritable bowel syndrome, are common, our understanding of them is limited.
The Joint Hypermobility Syndrome (JHS) is a common non-inflammatory
connective tissue disorder which is thought to be associated with FGID
although this has never been proven. Thus, further understanding of the link
between JHS and GI symptoms is warranted.
Our aim was to fully characterise the gastrointestinal (GI) manifestations of
JHS, to determine if there is a true association between GI symptoms in JHS
and FGID, and to determine the factors that are involved in this association.
Using a cross-sectional design I demonstrate in the first study that patients with
a known diagnosis of JHS who are referred from rheumatologists to
gastroenterologists have significantly increased gastro-oesophageal symptoms,
alternating bowel habit, bloating and abdominal pain compared to other patients
referred to the GI clinics. Autonomic factors, and to a lesser extent, somatic
hypersensitivity factors appear to mediate the association between JHS and
In the second study, I demonstrate that healthy university students with JHS are
more likely to experience postprandial dyspeptic symptoms compared to those
without JHS. Although autonomic and somatic symptoms are increased in JHS
their presence does not seem to confound the association with GI symptoms in
this group of healthy individuals.
In a case-control study of patients attending secondary care GI clinics, I
demonstrate that JHS is overrepresented in patients with FGID and reflux
disease but not in those with organic disease. Furthermore, the association with
FGID is specifically with postprandial distress syndrome and this association is
dependent on autonomic factors.
In the final chapter, I confirm that abnormalities in GI physiology are common in
JHS patients with GI symptoms attending a physiology unit. 60% of JHS
patients with reflux symptoms have non-erosive pathological acid reflux, 56%
with dysphagia have oesophageal hypomotility, and 87% with dyspeptic
symptoms have gastroparesis.
My studies suggest that there is overlap between JHS, gastro-oeosphageal
symptoms, FGID and GI dysmotility. Understanding the mechanisms underlying
GI involvement in JHS may further our understanding of FGID.||en_US