Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
Sidney Kimmel Medical College, Jefferson University Hospital, 1025 Walnut St #100, Philadelphia, PA, 19107, USA.
Dig Dis Sci. 2024 Mar;69(3):870-875. doi: 10.1007/s10620-023-08201-y. Epub 2023 Dec 19.
BACKGROUND: There is frequent overlap between and the connective tissue diseases Joint Hypermobility Syndrome/Ehlers-Danlos Syndrome (JHS/EDS) and disorders of the gut-brain interaction (DGBIs). AIMS: Because not all JHS/EDS patients develop DGBIs, we sought to determine whether secondary environmental triggers may lead to development of irritable bowel syndrome (IBS) and functional dyspepsia (FD) in patients with JHS/EDS. METHODS: We sent electronic surveys to 253 patients from a JHS/EDS support group, with responses collected over one year. IBS and FD were diagnosed by the Rome IV criteria, with additional validated assessments of adverse childhood experiences (ACEs) and traumatic stressors according to DSM-V criteria. We compared clinical and psychological characteristics of JHS/EDS patients with and without DGBIs using univariable and multivariable analyses. RESULTS: We enrolled 193 JHS/EDS patients, of whom 67.9% met Rome IV criteria for IBS. The IBS and JHS/EDS overlap group reported significantly more traumatic exposures (P < 0.001) and were more likely to have experienced greater than 3 ACEs (P < 0.001) than JHS/EDS patients without IBS. FD was found in 35.2% of patients and was associated with significantly more traumatic exposures (P < 0.001) and were more likely to have experienced greater than 3 ACEs (P < 0.001) than JHS/EDS patients without FD. CONCLUSIONS: We found that JHS/EDS patients with IBS and FD overlap reported significantly more traumatic exposures and ACEs compared to JHS/EDS patients without overlapping IBS or FD. JHS/EDS patients may have increased susceptibility to DGBIs, with traumatic life experiences and/or ACEs acting a secondary environmental trigger driving the subsequent development of DGBIs.
背景: 结缔组织疾病关节过度活动症/埃勒斯-当洛斯综合征(JHS/EDS)和肠-脑相互作用障碍(DGBIs)之间经常存在重叠。
目的: 由于并非所有 JHS/EDS 患者都会出现 DGBIs,我们试图确定 JHS/EDS 患者中,继发性环境触发因素是否会导致肠易激综合征(IBS)和功能性消化不良(FD)的发生。
方法: 我们向 JHS/EDS 支持小组的 253 名患者发送了电子调查问卷,并在一年时间内收集了回复。IBS 和 FD 根据罗马 IV 标准进行诊断,并根据 DSM-V 标准进一步进行了不良童年经历(ACEs)和创伤性应激源的验证评估。我们使用单变量和多变量分析比较了 JHS/EDS 患者中有无 DGBIs 的临床和心理特征。
结果: 我们共纳入了 193 名 JHS/EDS 患者,其中 67.9% 符合罗马 IV 标准的 IBS。IBS 和 JHS/EDS 重叠组报告的创伤性暴露明显更多(P<0.001),经历过 3 次以上 ACEs 的可能性更大(P<0.001)。FD 在 35.2%的患者中发现,与 JHS/EDS 患者中无 FD 的患者相比,FD 患者的创伤性暴露明显更多(P<0.001),且更有可能经历过 3 次以上 ACEs(P<0.001)。
结论: 我们发现,与无重叠 IBS 或 FD 的 JHS/EDS 患者相比,报告有 IBS 和 FD 重叠的 JHS/EDS 患者经历了更多的创伤性暴露和 ACEs。JHS/EDS 患者可能对 DGBIs 有更高的易感性,创伤性生活经历和/或 ACEs 作为继发性环境触发因素,随后导致 DGBIs 的发生。
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