The association between Ehlers- Danlos syndrome— hypermobility type and gastrointestinal symptoms in university students: a cross- sectional study

Background: Patients with EhlersDanlos syndrome—hypermobility type (EDSHT) have increased prevalence of gastrointestinal (GI) symptoms, particularly reflux and dyspepsia. EDSHT is associated with dysautonomia, psychopathology, and chronic pain which can be associated with GI symptoms. The association between GI symptoms and EDSHT in a ‘nonpatient’ population and the effect of the abovementioned factors has never been studied. Methods: In a cross sectional study, a hypermobility questionnaire was used to screen university students; further clinical examination established the diagnosis of EDSHT. Validated questionnaires assessed for GI, somatic, pain and autonomic symptoms, psychopathology and quality of life (QOL). These were compared in students with and without EDSHT; logistic regression analysis examined associations between EDSHT, GI symptoms and other variables. Key Results: Of 1998 students screened, 162 were included: 74 EDSHT (21.0 years, 53% female) vs 88 NonEDSHT (21.5 years, 65% female). Compared to nonEDSHT students, EDSHT 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 EDSHT and postprandial symptoms was dependent on autonomic factors but independent of pain and psychopathology. Painrelated QOL scores were reduced in the EDSHT group (80 vs 90, P=.03). Conclusions and Inferences: The previously described association between EDSHT, dyspepsia, pain and autonomic symptoms in patients is also present in nonpatient groups. Future studies are necessary to explore the etiological role of connective tissue in GI and extra intestinal symptoms.