Introduction Generalised joint hypermobility (HM) refers to an increased flexibility of the joints which is present in 5–17% of the population, and is assessed by clinical examination or validated hypermobility questionnaire. HM is associated with increased incidence of somatic pain and hypersensitivity, but its relationship with visceral hypersensitivity is unknown. Gastro-oesophageal reflux symptoms occur in over 50% of hypermobile patients (1). We hypothesised that we would observe a higher prevalence of HM in patients with hypersensitive oesophagus compared to patients with either erosive (GERD) or non erosive (NERD) reflux disease, functional heartburn, or a healthy control group.
Methods A cross sectional study of patients attending our GI physiology unit for investigation of reflux symptoms between Jan 2010 and March 2012 was undertaken. Patients completed the validated joint hypermobility questionnaire; scores ≥2 out of 5 represented HM (Hakim 2003). Information from gastrosocopy and physiology testing was used to determine whether patients had GERD, NERD, hypersensitive oesophagus, or functional heartburn. Patients who were on PPI were excluded. Hypermobility questionnaire data from a group of 250 healthy volunteers was obtained from another study.
Results 457 (59% female, age range: 15–79) patients with complete data were included. HM was present in 79 (17%) patients. The prevalence of HM was highest in patients diagnosed with hypersensitive oesophagus (31%) and lowest in NERD (15%)-see table 1. The prevalence of HM was significantly higher in hypersensitive oesophagus (31%) compared to the combined prevalence in other reflux diagnoses (16%), p = 0.009, and to the healthy control group (18%), p = 0.04.
Conclusion 17% of patients with reflux symptoms severe enough to warrant physiology investigation have HM, which is similar to the prevalence in healthy controls. The prevalence of HM in patients with hypersensitive oesophagus (31%) was almost twice as high as in healthy controls, whereas, the prevalence in other subgroups (GERD, NERD) is similar to that of controls. This suggests that the link between HM and gastro-oesopheageal reflux disease is related to visceral hypersensitivity, rather than to increased reflux. HM appears to be a risk factor for oesophageal hypersensitivity, and may contribute to the pathogenesis of this reflux entity.
Disclosure of Interest None Declared
Castori, M., et al., Natural history and manifestations of the hypermobility type Ehlers-Danlos syndrome: a pilot study on 21 patients. Am J Med Genet A. 152A(3): p. 556–64.