Why are more patients with hypermobility syndromes experiencing unexpected gastrointestinal symptoms, and what does it mean for their treatment?
Story Summary
- Increase in hypermobility syndromes with GI symptoms prompts new guidance.
- American Gastroenterological Association issues clinical practice guidelines.
- Hypermobility can lead to complex multisystemic symptoms.
- Awareness and accurate diagnosis are crucial for effective management.
- Understanding the Complexities of Hypermobility Syndromes
An increasing number of patients are presenting with hypermobile Ehlers-Danlos syndrome (hEDS) alongside gastrointestinal (GI) symptoms, postural orthostatic tachycardia syndrome (POTS), and mast cell activation syndrome (MCAS). This rise has led the American Gastroenterological Association (AGA) to release new guidance to help clinicians navigate these complex cases. These overlapping syndromes present substantial challenges, often leaving healthcare providers feeling underprepared to address the needs of their patients.
According to the AGA, many patients with hypermobility spectrum disorders experience pain and joint hypermobility, with a startling 98% also suffering from GI symptoms. This staggering statistic suggests that gastroenterologists might encounter these patients more frequently than previously thought. Dr. Lucinda A. Harris from the Mayo Clinic School of Medicine emphasizes that hypermobility may predispose individuals to disorders of brain-gut interaction, indicating a need for more comprehensive diagnostic approaches.
Clinical Practice Guidance and Recommendations
The AGA’s guidance offers several recommendations for clinicians. While testing for POTS and MCAS should be targeted, universal testing for these conditions in all patients with hEDS or hypermobility spectrum disorders isn’t currently supported by the evidence. Gastroenterologists should consider joint hypermobility during assessments and potentially use the Beighton score for screening. If positive, further evaluation using the 2017 diagnostic criteria for hEDS or referral to a specialist may be necessary.
Management of GI symptoms should focus on identifying and treating the most prominent symptoms and abnormal test results. It’s critical to address any symptoms linked to POTS or MCAS, with treatments including increased fluid and salt intake, exercise training, and compression garments. For patients unresponsive to lifestyle modifications, pharmacological treatments involving multiple specialties should be considered.
Misdiagnosis and the Importance of Awareness
Patients with gut-brain disorders are often misdiagnosed with conditions like irritable bowel syndrome, while their true condition may remain overlooked. For example, constipation in patients with Ehlers-Danlos syndrome might stem from pelvic floor dysfunction due to hypermobility, leading to more severe complications if not correctly identified.
These syndromes primarily affect women aged 18 to 50, although no genetic test currently exists for hEDS. Clinicians should consider POTS and Ehlers-Danlos syndrome when treating young females presenting with symptoms such as palpitations, hypermobility, and orthostatic intolerance.
The Role of Education and Advocacy
Dr. Clair Francomano of Indiana University School of Medicine highlights the importance of the new guidance. It encourages gastroenterologists to consider conditions like EDS, POTS, and MCAS when evaluating patients with gut-brain interaction disorders. This approach can lead to more accurate diagnoses and effective management. The Ehlers-Danlos Society, through advocacy and education, has been instrumental in raising awareness of these overlapping conditions, facilitating better outcomes for patients.
Clinicians are urged to provide informed counseling and steer patients away from unreliable information sources, fostering therapeutic relationships built on evidence-based care. The message is clear: when encountering gut-brain axis disorders, clinicians should consider the possibility of joint hypermobility or Ehlers-Danlos syndrome.
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