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Gastrointestinal symptoms and nutritional issues in patients with hypermobility disorders: assessment, diagnosis and management
  1. Ching Lam1,
  2. Gehanjali Amarasinghe2,
  3. Natalia Zarate-Lopez3,
  4. Asma Fikree4,
  5. Peter Byrne5,
  6. Sorena Kiani-Alikhan6,
  7. Simon Gabe2,7,
  8. Peter Paine8
  1. 1Gastroenterology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
  2. 2Gastroenterology, St Marks Hospital, London North West University Healthcare NHS Trust, Harrow, UK
  3. 3Gastoenterology and GI physiology, University College London Hospitals NHS Foundation Trust, London, UK
  4. 4Gastroenterology, Barts Health NHS Trust, London, UK
  5. 5Psychiatry, East London NHS Foundation Trust, London, UK
  6. 6Immunology Barts Health NHS Trust, London, UK
  7. 7Intestinal Failure Unit, St Mark's Hospital and Academic Institute, Harrow, UK
  8. 8Gastroenterology, Salford Royal NHS Foundation Trust, Salford, UK
  1. Correspondence to Dr Peter Paine, Gastroenterology, Salford Royal NHS Foundation Trust, Salford, UK; peter.paine{at}


Patients diagnosed with hypermobile Ehlers-Danlos syndrome and hypermobile spectrum disorders are increasingly presenting to secondary and tertiary care centres with gastrointestinal (GI) symptoms and nutritional issues. Due to the absence of specific guidance, these patients are investigated, diagnosed and managed heterogeneously, resulting in a growing concern that they are at increased risk of iatrogenic harm. This review aims to collate the evidence for the causes of GI symptoms, nutritional issues and associated conditions as well as the burden of polypharmacy in this group of patients. We also describe evidence-based strategies for management, with an emphasis on reducing the risk of iatrogenic harm and improving multidisciplinary team care.


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  • Contributors CL and GA contributed equally to this article as first authors and PP as senior author and all also contributed sections NZ-L, AF, PB, SK-A and SG all contributed sections and final review of the article.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests AF has received research project funding from EDS-UK. There are no other competing interests for other authors.

  • Provenance and peer review Commissioned; externally peer reviewed.

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