Document Detail

Joint hypermobility and rectal evacuatory dysfunction: an etiological link in abnormal connective tissue?
MedLine Citation:
PMID:  20618831     Owner:  NLM     Status:  MEDLINE    
BACKGROUND:   Previous studies report an association between joint hypermobility (JHM), as a clinical feature of underlying connective tissue (CT) disorder, and pelvic organ prolapse. However, its association with rectal evacuatory dysfunction (RED) has not been evaluated. To investigate the prevalence of JHM in the general population and in patients with symptoms of RED referred for anorectal physiological investigation.
METHODS: Bowel symptom and Rome III questionnaires to detect irritable bowel syndrome were sent to 273 patients with RED. Patients then underwent full investigation, including evacuation proctography. A validated 5-point self-reported questionnaire was used to assess JHM in both the patient group and 100 age- and sex-matched controls [87 female, median age 55 (range 28-87)].
KEY RESULTS: Seventy-three patients were excluded from analysis (incomplete questionnaire or investigation). Of 200, 65 patients [32%: 63 female, median age 52 (range 15-80)] and 14% of controls (P = 0.0005 vs patients) had features satisfying criteria for JHM. Overall constipation score (P < 0.0001), abdominal pain (P = 0.003), need for manual assistance (P = 0.009), and use of laxatives (P = 0.03) were greater in the JHM group than the non-JHM group. On proctography, 56 of JHM patients (86%) were found to have significant morphological abnormalities (e.g. functional rectocoele), compared with 64% of the non-JHM group (P = 0.001).
CONCLUSIONS & INFERENCES: The greater prevalence of JHM in patients with symptoms of RED, and the demonstration of significantly higher frequencies of morphological abnormalities than those without JHM, raises the possibility of an important pathoaetiology residing in either an enteric or supporting pelvic floor abnormality of CT.
S D Mohammed; P J Lunniss; N Zarate; A D Farmer; R Grahame; Q Aziz; S M Scott
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2010-07-05
Journal Detail:
Title:  Neurogastroenterology and motility : the official journal of the European Gastrointestinal Motility Society     Volume:  22     ISSN:  1365-2982     ISO Abbreviation:  Neurogastroenterol. Motil.     Publication Date:  2010 Oct 
Date Detail:
Created Date:  2010-09-15     Completed Date:  2011-01-07     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9432572     Medline TA:  Neurogastroenterol Motil     Country:  England    
Other Details:
Languages:  eng     Pagination:  1085-e283     Citation Subset:  IM    
GI Physiology Unit (Academic Surgical Unit) and Neurogastroenterology Group, Centre for Digestive Diseases, Institute of Cell and Molecular Science, Barts and the London School of Medicine and Dentistry, London, UK.
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MeSH Terms
Aged, 80 and over
Connective Tissue / physiopathology*
Connective Tissue Diseases / physiopathology*
Constipation / etiology,  physiopathology
Defecation / physiology
Joint Instability / physiopathology*
Middle Aged
Rectal Diseases / physiopathology*
Rectum / physiopathology*
Young Adult
Grant Support
//Medical Research Council

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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