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Why being double-jointed can be a pain in the gut

Scientists from Queen Mary University of London are carrying out groundbreaking research which, for the first time, investigates the link between hypermobility (double-jointedness) and gut disorders.

They want to know why hypermobile (double-jointed) patients with flexible joints and stretchy skin are more likely to have digestive problems and stomach pain.

The study focuses on connective tissue which is found throughout the body and acts as scaffolding, supporting and binding all the other organs and tissues.

The researchers have observed that:

  • connective tissue may form “the missing link” between hypermobility and gut disorders;
  • patients with joint hypermobility, who have a genetic defect in the connective tissue, may also be likely to have abnormal connective tissue in their gut.

This was the first study to investigate the association between the two conditions. It was funded by the charity Bowel & Cancer Research.

The findings provide hypermobility patients with a possible explanation for their symptoms and reassures them that gut disorders may be a key part of their disease. It also allows doctors to treat patients holistically, rather than focussing on organ-specific pain.

Qasim Aziz, Professor of Neurogastroenterology at Queen Mary University of London, led the research. The clinical research fellow who collected the data was Dr Asma Fikree, also from Queen Mary.

“Patients with hypermobility disorder often suffer chronic abdominal pain and a range of gut symptoms. They are frequently misdiagnosed, undiagnosed or wrongly diagnosed and have poor quality of life,” said Professor Aziz.

“Our research has demonstrated that there is a potential association between hypermobile joints and gut symptoms. This observation allows us to provide a better explanation of symptoms to our patients and tailor our treatments more effectively.”

He hopes that physicians throughout the world will be made aware of the association between the two conditions, and that diagnosis and therefore appropriate treatment will become more routine.

The findings are published in the journal Clinical Gastroenterology and Hepatology.

Professor Aziz’s research team studied 708 patients who suffered from a range of conditions including Irritable Bowel Syndrome and reflux disorders for which there is no cure.

One of them was Lara Bloom, 33, who has Ehlers-Danlos Syndrome, a genetic condition which affects the joints. As well as being hypermobile, she suffers from constipation, stomach pain, bladder problems and gynaecological issues.

“The symptoms began when I was 13 but no one picked up that my flexible joints were connected to the gut problems.

“It was put down to growing pains, hypochondria, not having a very high pain threshold. I was 24 when I was finally diagnosed,” said Lara, now 33 and living in Hertfordshire.

“My diagnosis brought a lot of relief. After 13 years of chronic pain, there was finally a reason and I knew I wasn’t going mad and I could live a long life.”

The aim of the Professor Aziz’s research project was to investigate the importance of connective tissue and its relationship to functional gastrointestinal disorders (FGID) where no apparent cause could be found.

In a large epidemiology case-control study, scientists compared the prevalence of hypermobility in patients with and without gut disorders to discover whether they were linked, and if so, how.

A total 708 patients were split into those with gastrointestinal (GI) disorders (eg, Irritable Bowel Syndrome), those with organic diagnosis (eg, stomach ulcers), and those with a reflux disorder (eg, acid reflux disease).

The prevalence of hypermobility was highest in those with Functional Gastrointestinal Disorders (FGID) (38%) and reflux disease (40%), as compared to those with organic GI disease (26%) and patients without GI disorders (26%).

Hypermobile patients were also found to be more likely to have postprandial problems (ie, after eating), bladder problems and stomach pains.

Professor Aziz is now seeking funding for a large-scale project to investigate further the links between hypermobility and gut disorders so that more effective treatment can be developed, hopefully in the next five to 10 years.

“A lot more research is required to understand the scientific basis of this link,” he said.


A Prospective Evaluation of Undiagnosed Joint Hypermobility Syndrome in Patients with Gastrointestinal Symptoms. Asma Fikree, Rodney Grahame, Rubina Aktar, Adam D Farmer, Alan J Hakim, Joan K Morris, Charles H Knowles, Qasim Aziz. Clinical Gastroenterology and Hepatology, DOI:10.1016/j.cgh.2014.01.014, published online 21 January 2014.

The Association Between Functional Gastrointestinal Disorders and the Joint Hypermobility Syndrome – Connective Tissue is the Missing Link! Gastroenterology, http://download.journals.elsevierhealth.com/pdfs/journals/0016-5085/PIIS0016508513620004.pdfIt is the summary of an abstract presented at Digestive Disease Week conference in Orlando, USA in May 2013.

Bowel Cancer Research