Fikree A, Aktar R, Morris J K, Grahame R, Knowles C H, Aziz Q
Wingate Institute of Neurogastroenterology, Centre for Neuroscience and Trauma, Bizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
Neurogastroenterol Motil. 2017 Mar;29(3). doi: 10.1111/nmo.12942. Epub 2016 Sep 28.
Patients with Ehlers-Danlos syndrome-hypermobility type (EDS-HT) have increased prevalence of gastrointestinal (GI) symptoms, particularly reflux and dyspepsia. EDS-HT is associated with dysautonomia, psychopathology, and chronic pain which can be associated with GI symptoms. The association between GI symptoms and EDS-HT in a 'non-patient' population and the effect of the above-mentioned factors has never been studied.
In a cross sectional study, a hypermobility questionnaire was used to screen university students; further clinical examination established the diagnosis of EDS-HT. Validated questionnaires assessed for GI, somatic, pain and autonomic symptoms, psychopathology and quality of life (QOL). These were compared in students with and without EDS-HT; logistic regression analysis examined associations between EDS-HT, GI symptoms and other variables.
Of 1998 students screened, 162 were included: 74 EDS-HT (21.0 years, 53% female) vs 88 Non-EDS-HT (21.5 years, 65% female). Compared to non-EDS-HT students, EDS-HT students were more likely to have multiple GI symptoms (41.9% vs 27.3% P=.05), particularly postprandial fullness (34.4% vs 15.9%, P=.01) and early satiety (32% vs 17%, P=.03), greater autonomic (P<.001) and somatic symptoms (P=.04) but not psychopathology (P>.8). The association between EDS-HT and postprandial symptoms was dependent on autonomic factors but independent of pain and psychopathology. Pain-related QOL scores were reduced in the EDS-HT group (80 vs 90, P=.03).
The previously described association between EDS-HT, dyspepsia, pain and autonomic symptoms in patients is also present in non-patient groups. Future studies are necessary to explore the etiological role of connective tissue in GI and extra intestinal symptoms.
患有高活动型埃勒斯-当洛综合征（EDS-HT）的患者胃肠道（GI）症状的患病率增加，尤其是反流和消化不良。EDS-HT与自主神经功能障碍、精神病理学和慢性疼痛有关，而这些又可能与胃肠道症状相关。从未研究过“非患者”人群中胃肠道症状与EDS-HT之间的关联以及上述因素的影响。
在一项横断面研究中，使用高活动问卷对大学生进行筛查；进一步的临床检查确立了EDS-HT的诊断。使用经过验证的问卷评估胃肠道、躯体、疼痛和自主神经症状、精神病理学和生活质量（QOL）。对患有和未患有EDS-HT的学生进行了比较；逻辑回归分析检查了EDS-HT、胃肠道症状和其他变量之间的关联。
在筛查的1998名学生中，162名被纳入研究：74名EDS-HT患者（年龄21.0岁，53%为女性）与88名非EDS-HT学生（年龄21.5岁，65%为女性）。与非EDS-HT学生相比，EDS-HT学生更有可能出现多种胃肠道症状（41.9%对27.3%，P=0.05），尤其是餐后饱胀感（34.4%对15.9%，P=0.01）和早饱感（32%对17%，P=0.03），自主神经症状（P<0.001）和躯体症状（P=0.04）更明显，但精神病理学方面无差异（P>0.8）。EDS-HT与餐后症状之间的关联取决于自主神经因素，而与疼痛和精神病理学无关。EDS-HT组与疼痛相关的生活质量评分降低（80对90，P=0.03）。
先前描述的患者中EDS-HT、消化不良、疼痛和自主神经症状之间的关联在非患者群体中也存在。未来有必要进行研究以探讨结缔组织在胃肠道和肠外症状中的病因学作用。
