Mechanisms underlying reflux symptoms and dysphagia in patients with joint hypermobility syndrome, with and without postural tachycardia syndrome

摘要

Abstract Background The joint hypermobility syndrome ( JHS ) is a common non‐inflammatory connective tissue disorder which frequently co‐exists with postural tachycardia syndrome (Po TS ), a form of orthostatic intolerance. Gastrointestinal symptoms and dysmotility have been reported in Po TS . Dysphagia and reflux are common symptoms in JHS , yet no studies have examined the physiological mechanism for these, subdivided by Po TS status. Methods Thirty patients (28 female, ages: 18‐62) with JHS and symptoms of reflux (n=28)?±?dysphagia (n=25), underwent high‐resolution manometry and 24?hour pH ‐impedance monitoring after questionnaire‐based symptom assessment. Esophageal physiology parameters were examined in JHS , subdivided by Po TS status. Results Fifty‐three percent of JHS patients with reflux symptoms had pathological acid reflux, 21% had reflux hypersensitivity, and 25% had functional heartburn. Acid exposure was more likely to be increased in the recumbent than upright position (64% vs 43%). The prevalence of hypotensive lower esophageal sphincter (33%) and hiatus hernia (33%) was low. Forty percent of patients with dysphagia had minor disorders of motility, 60% had functional dysphagia. Eighteen (60%) patients had coexistent Po TS —they had significantly higher dysphagia (21 vs 11.5, P =.04) and reflux scores (24.5 vs 16.5, P =.05), and double the prevalence of pathological acid reflux (64% vs 36%, P =.1) and esophageal dysmotility (50% vs 25%, P =.2) though this was not significant. Conclusions and Inferences A large proportion of JHS patients with esophageal symptoms have true reflux‐related symptoms or mild esophageal hypomotility, and this is more likely if they have Po TS .