Joint Hypermobility Syndrome Affects Response to a Low Fermentable Oligosaccharide, Disaccharide, Monosaccharide and Polyol Diet in Irritable Bowel Syndrome Patients: A Retrospective Study

Abstract

Background The low fermentable oligosaccharide, disaccharide, monosaccharide and polyol (FODMAP) diet causes significant clinical improvement in patients with irritable bowel syndrome (IBS). Joint hypermobility syndrome (JHS), defined as musculoskeletal symptoms in a hypermobile individual in the absence of systemic rheumatological disease, may be associated with functional gastrointestinal symptoms, including IBS. The aim of this study is to examine whether JHS can affect the response to the low FODMAP diet in patients with IBS. Methods In this retrospective study, we included patients with IBS according to Rome III criteria who had followed a low FODMAP diet. Symptoms scores were measured before and after the low FODMAP diet. Results A total of 165 patients (130 females, age 44 ± 14 years) were included. Diarrhea predominant IBS (IBS-D) was present in 40.6% of our patients while JHS was present in 21.2%. The score for abdominal pain was higher for JHS compared to non-JHS prior to intervention (P = 0.011). Symptoms improved in both groups of patients after a low FODMAP diet (P < 0.0001). The largest effects were shown with significant decreases of the average score and bloating. When broken down by JHS and IBS type, a low FODMAP diet significantly improved pain, bloating, diarrhea, constipation, and the average score with the largest effect in JHS/constipation predominant IBS (IBS-C), JHS/mixed IBS and unclassified IBS (IBS-M), JHS/IBS-D, non-JHS/IBS-C and JHS/IBS-M, respectively. Conclusions Our study suggests that a low FODMAP diet has a greater effect on IBS symptoms in JHS than non-JHS patients.

Hypermobile Ehlers–Danlos syndrome and disorders of the gastrointestinal tract: What the gastroenterologist needs to know

“…Evidence for management specifically in HSD/hEDS lacking–attention to: Integrated care and behavioral therapies 85 Dietary management: FODMAP diet efficacious in HSD/hEDS‐related DGBI 89 Pelvic floor dysfunction: consider early referral for anorectal physiological assessment and biofeedback/pelvic floor physiotherapy Psychology input to address psychological comorbidity …”

Overlap between irritable bowel syndrome and hypermobileEhlers–Danlossyndrome: An unexplored clinical phenotype?

“…A recent publication demonstrated that hEDS patients with IBS respond better to the FODMAP diet than IBS patients without hEDS (Fragkos et al, 2019). This finding suggests that the overlap IBS/hEDS group form a distinct group with more dietary influences and that this group may be handling food and nutrients differently than those with IBS alone.…”

In-VitroEfficacy of Targeted FODMAP Enzymatic Digestion (FODZYME®) in a High-Fidelity Simulated Gastrointestinal Environment

“…The high safety profile allows for use as sole therapy in patients with symptoms not meeting the need for daily therapeutics like tricyclic antidepressants or selective serotonin reuptake inhibitors, as well as an adjunct therapeutic for patients with higher acuity disease. This finding has tremendous implications for patients with a myriad of conditions, ranging from IBD and non-responsive celiac disease to IBS and other diseases of gut-brain interaction (functional dyspepsia, etc), and is of particular note for patients with IBS/DGBI and benign hypermobility given the high efficacy of a low-FODMAP diet in this population 32 .…”