Wingate Institute of Neurogastroenterology, Centre for Digestive Diseases, Blizard Institute of Cell and Molecular Science, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom.
Department of Rheumatology, University College Hospital NHS Trust, London, United Kingdom.
Clin Gastroenterol Hepatol. 2014 Oct;12(10):1680-87.e2. doi: 10.1016/j.cgh.2014.01.014. Epub 2014 Jan 16.
BACKGROUND & AIMS: The Joint Hypermobility Syndrome (JHS) is a common connective tissue disorder characterized by joint hyperflexibility, dysautonomia, and chronic pain. Gastrointestinal (GI) symptoms are reported in JHS patients attending rheumatology clinics, but the prevalence and symptom pattern of previously undiagnosed JHS in GI clinics are unknown. METHODS: By using validated questionnaires, a prospective cross-sectional study in secondary care GI clinics estimated the prevalence of JHS in new consecutively referred patients, compared GI symptoms in patients with and without JHS, and by using multiple regression determined whether the burden of GI symptoms in JHS patients was dependent on chronic pain, autonomic, psychological, and medication related factors. A positive control group consisted of JHS patients referred from rheumatology clinics with GI symptoms (JHS-Rh). RESULTS: From 552 patients recruited, 180 (33%) had JHS (JHS-G) and 372 did not (non-JHS-G). Forty-four JHS-Rh patients were included. JHS-G patients were more likely to be younger, female with poorer quality of life (P = .02) than non-JHS-G patients. After age and sex matching, heartburn (odds ratio [OR], 1.66; confidence interval [CI], 1.1-2.5; P = .01), water brash (OR, 2.02; CI, 1.3-3.1; P = .001), and postprandial fullness (OR, 1.74; CI, 1.2-2.6; P = .006) were more common in JHS-G vs non-JHS-G. Many upper and lower GI symptoms increased with increasing severity of JHS phenotype. Upper GI symptoms were dependent on autonomic and chronic pain factors. CONCLUSIONS: JHS is common in GI clinics, with increased burden of upper GI and extraintestinal symptoms and poorer quality of life. Recognition of JHS will facilitate multidisciplinary management of GI and extra-GI manifestations.
背景与目的:联合运动过度综合征(JHS)是一种常见的结缔组织疾病,其特征为关节过度活动、自主神经功能紊乱和慢性疼痛。在风湿科就诊的 JHS 患者中报告有胃肠道(GI)症状,但在 GI 科就诊的未经诊断的 JHS 患者的患病率和症状模式尚不清楚。
方法:通过使用经过验证的问卷,对二级保健 GI 诊所的新连续转诊患者进行前瞻性横断面研究,评估 JHS 的患病率,并比较 JHS 患者和非 JHS 患者的 GI 症状,通过多元回归确定 JHS 患者的 GI 症状负担是否依赖于慢性疼痛、自主神经、心理和药物相关因素。阳性对照组由风湿科就诊的有 GI 症状的 JHS 患者(JHS-Rh)组成。
结果:在招募的 552 名患者中,有 180 名(33%)患有 JHS(JHS-G),372 名没有(非 JHS-G)。纳入了 44 名 JHS-Rh 患者。JHS-G 患者比非 JHS-G 患者更年轻、女性,生活质量更差(P =.02)。在年龄和性别匹配后,烧心(比值比 [OR],1.66;置信区间 [CI],1.1-2.5;P =.01)、水逆(OR,2.02;CI,1.3-3.1;P =.001)和餐后饱胀(OR,1.74;CI,1.2-2.6;P =.006)在 JHS-G 中比非 JHS-G 更常见。许多上消化道和下消化道症状随着 JHS 表型严重程度的增加而增加。上消化道症状取决于自主神经和慢性疼痛因素。
结论:JHS 在 GI 诊所中很常见,上消化道和肠外症状的负担增加,生活质量下降。对 JHS 的认识将有助于对 GI 和肠外表现进行多学科管理。
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