NERD constitutes a heterogeneous group of patients. One of the subgroups includes those patients that have been termed as functional heartburn. The “Rome II” committee for functional oesophageal disorders defined functional heartburn as an episodic retrosternal burning in the absence of pathological gastro-oesophageal reflux, pathology based motility disorders, or structural explanations.13 This definition is vague and clearly does not provide any clues to the different underlying mechanisms that may lead to heartburn in these patients. When it comes to understanding symptoms in GORD and specifically in patients with functional heartburn, a traditional “intraluminal” view is insufficient. Other factors including central and peripheral neural mechanisms should be taken into consideration in order to understand the basis of the symptoms experienced by these patients.
P6/FIV is the 4-year-old brother of P5/FIV. Talipes and polyhydramnios were noted antenatally. He was born by emergency Cesarean section at 38 weeks gestation and required intubation and ventilation on the first day of life. He was floppy at birth and had clenched hands and overlapping fingers.
A link between hEDS and bacterial overgrowth has not been categorically established and further research is required. Ehlers-Danlos syndrome can take one of several forms and is believed to affect 1.5 million people around the globe. Classified at the beginning of the 20th century, Ehlers-Danlos syndrome is inherited, passed from parent to child. A much rarer group of connective tissue disorders is called Ehlers-Danlos syndrome.
Joint pain often comes from the tendons and muscles around the joint rather than the joint itself, so that x-rays may be normal. Often, people who suffer from hypermobility syndrome are called hypo- chondriacs or lazy because they avoid many everyday activities, because these activities that cause them pain. Most of them don’t look sick and, as a total result, friends, colleagues, and even doctors can be unsympathetic. Furthermore, they may spend years unsuccessfully searching for the cause of their chronic pain and other symptoms because many doctors are unfamiliar with hypermobility syndrome and its complex set of symptoms.
Raynauds phenomenon consists of vasospastic attacks in the digits, and may be found associated with an autoimmune disorder. We have found a high incidence of the above autoimmune disorders in a cohort of 72 consecutive EDS patients enrolled at the National Institute on Aging study 2003-086. In longitudinal follow-up 5/25 adults 40 years or older developed RA. One adult over 40 presented with a diagnosis of EDS and SLE.
Patients with EDS can come to the doctor with hernias, out of place organs, and prolapse, as well as functional problems such as changes in the speed of the digestive system (gut motility). Patients with hypermobile EDS (hEDS) show GI symptoms related to the gut and often meet the criteria for disorders such as indigestion and irritable bowel syndrome. The presence of GI symptoms in EDS patients influences their quality of life.
Functional bowel disorders are underrecognized and common, affecting 33%-67% of individuals with hEDS [Levy et al 1999, Castori et al 2010a]. Feature B. Positive family history, with one or more first-degree relatives independently meeting the current diagnostic criteria for hEDS..
Although hEDS is characterized by musculoskeletal symptoms, it is often the non-musculoskeletal symptoms that cause the most difficulty for some patients. Some experts believe that JHS is the same thing as the hypermobile type of Ehlers-Danlos syndrome (EDS), a condition caused by extreme elasticity of body tissues also. People with the hypermobile type of EDS have loose joints and soft, velvety skin, as well as other symptoms almost identical to those described here. For most people, the distinction between joint hypermobility, joint hypermobility syndrome, and the hypermobile type of Ehlers-Danlos is clinically not an important one, as treatments are similar.
Flow Chart of the functional bowel disorders among the population of Ehlers-Danlos syndrome. Combining the MS and hEDS patients together, these patients were more likely to report a wide range of gastrointestinal symptoms compared to controls (Table 1). 90 patients and 90 controls were included in this scholarly study. Data was collected from 45 MS patients (12 males and 33 females, age 19-41, mean 28 years) with no organic gastrointestinal diagnosis.
The Ehlers Danlos syndromes (EDS) are a group of conditions usually (although not always) inherited from your parents. People with EDS have a problem with the formation and structure of connective tissue in the physical body. Connective tissue is a important component of skin particularly, muscles and ligaments, blood vessels and heart valves. The Ehlers-Danlos syndromes (EDS) are a group of conditions that affect the stretchiness and strength of supporting tissues in the body, including skin, joints, blood vessels and internal organs.
It is, therefore, likely that opioids shall be considered in the management of these patients, which can influence GI function and lead to deterioration in symptoms significantly. Hence, avoidance of opioids should be a consideration in those with GI involvement. A band of muscle fibers, the lower esophageal sphincter, closes off the esophagus from the stomach. If the sphincter does not close properly, food and liquid can move backward into the esophagus and cause heartburn and other symptoms known as gastroesophageal disease (GERD).
Below are the main symptoms seen in the different types of EDS. The other forms of EDS are very uncommon. The classical type of EDS occurs in 1 in 20,000 to 1 in 40,000 people. The other types are very rare.
Management of dEDS
The mechanisms responsible for pain, clinical characteristics, and the optimal therapeutic approach remain understood poorly. Response to potent antireflux treatment is relatively limited. Current and future treatment strategies for functional heartburn patients who have failed standard dose proton pump inhibitors (PPIs) include increased PPI dose in some, as well as addition of pain modulators in others. Fibromyalgia is a common diagnosis in people with JHS.