Re: * Dysphagia in patients with the joint hypermobility syndrome - VERY INTERES

[Guest guest]

Small study but VERY INTERESTING. I have joint hypermobility. You should see the

things I can do with my fingers. I can bend them all the way back and also bend

them over eachother. Its scary and I have done this my entire life. I only have

it in my hands though....

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> Gut

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> 2011;60:A181

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> doi:10.1136/gut.2011.239301.385

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> Posters

> GI physiology

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> * Dysphagia in patients with the joint

hypermobility

syndromehttp://gut.bmj.com/content/60/Suppl_1/A181.1.abstract?ct=ct

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> A Fikree *1,

> Q Aziz1,

> J Jafari1,

> R Grahame2,

> D Sifrim1+ Author Affiliations

> 1Neurogastroenterology, Blizard Institute of

Cell and Molecular Science, Barts and the London School of Medicine and

Dentistry,

> London, UK

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> 2Rheumatology, University College Hospital,

London, UK

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> Abstract

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> Introduction

> The Joint Hypermobility Syndrome (JHS) is a relatively frequent

> inherited connective tissue disorder characterised by marked

> joint hyperextensibility and

> extra-articular manifestations. Recent work suggests that

> gastrointestinal (GI) symptom prevalence

> may be as high as 86%1 in these patients,

and that many of them have evidence of GI dysmotility.2 Dysphagia is a symptom

which is not uncommon in these patients, but which has never been formally

studied. In general terms,

> dysphagia is either due to a structural

abnormality of the oesophagus or a motility problem.

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> Methods A

> single-centre retrospective observational study was carried out to

> characterise the cause of non-structural dysphagia in

> patients with JHS. JHS patients who

> were referred to the upper GI physiology unit and who complained of

> dysphagia were identified.

> Their HRM and 24-h pH-metry traces

> were analysed to characterise oesophageal motility, presence of a hiatus

> hernia, lower

> oesophageal sphincter (LOS) pressure

> and presence of gastro-oesophageal reflux (GOR).

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> Results 17

> patients with JHS and dysphagia were referred by the rheumatologists to

> our unit in 1 year: 76% female; age range: 12†" 58. None had evidence of a

> structural cause for the dysphagia on either gastroscopy or barium

> studies. 10 (59%) had an oesophageal dysmotility to account for their

> dysphagia †" out of these one had achalasia; the other 9 (53%) had

> oesophageal hypomotility with 7 having frequent hypotensive peristalsis

> and 2 having intermittent hypotensive peristalsis. 33% of those with

> hypomotility had a normal Multiple Rapid Swallow test (MRS). 7 of the 17

> patients (41%) had normal oesophageal motility and 6 of these had

> reflux studies: 50% had GOR, 17% had a hypersensitive oesophagus and the

> remaining 33% had normal studies. Only 2 patients (12%) had hiatus

> hernias and both of these had oesophageal hypomotility and no GOR.

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> Conclusion

> This is the first study of upper GI physiology in patients with JHS and

> non-structural dysphagia. Oesophageal hypomotility

> is common in these patients and

> those patients with normal MRS are likely to show the best response to

> prokinetics. 50% of

> those with normal motility had

> pathological GOR and would benefit from high dose proton pump inhibitor

> therapy. The remainder

> had normal studies, suggesting

> hypersensitivity which may respond to treatment with neuromodulators

> such as amitriptyline.

> Only 12% of patients had a hiatus

> hernia, which is in contrast to previous studies.3 Further prospective studies

are required to understand the pathophysiology and management options for

dysphagia in JHS.

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>   California Collegiate Shooting Sports 4-H All-Star Advisor to the

most awesome  kids of Amador County!

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