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Title: The prevalence of hypermobility in children with irritable bowel syndrome and functional abdominal pain is similar to that in healthy children

Author
item SHULMAN, ROBERT - Children'S Nutrition Research Center (CNRC)
item SELF, MARIELLA - Texas Children'S Hospital
item CZYZEWSKI, DANITA - Baylor College Of Medicine
item GOLDBERG, JERRY - Marshfield Clinic Research
item HEITKEMPER, MARGARET - University Of Washington

Submitted to: Journal of Pediatrics
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 3/16/2020
Publication Date: 5/4/2020
Citation: Shulman, R.J., Self, M.M., Czyzewski, D.I., Goldberg, J., Heitkemper, M. 2020. The prevalence of hypermobility in children with irritable bowel syndrome and functional abdominal pain is similar to that in healthy children. Journal of Pediatrics. 222:134-140. https://doi.org/10.1016/j.jpeds.2020.03.033.
DOI: https://doi.org/10.1016/j.jpeds.2020.03.033

Interpretive Summary: Joints that are very flexible can be associated with a number of medical conditions. It had been thought that children with irritable bowel syndrome and functional abdominal pain have hyperflexible joints but this study showed it is not the case. These findings are important to help determine if physical interventions addressing this matter may be needed to improve the child's quality of life.

Technical Abstract: To test the hypothesis that the prevalence of joint hypermobility is greater in children with irritable bowel syndrome and functional abdominal pain than in healthy control children and is related to gastrointestinal symptoms and psychosocial distress (anxiety, depression, and somatization). Children (irritable bowel syndrome, n = 109; functional abdominal pain, n = 31; healthy control, n = 69), 7-12 years of age completed prospective 2-week pain and stooling diaries and child- and parent-reported measures of anxiety, depression, and somatization. Joint hypermobility was determined using Beighton criteria (score of >=4 or 6). We also examined possible relationships between Beighton score, race, body mass index, gastrointestinal symptoms, and psychosocial distress.Beighton scores were similar between groups, as was the proportion with joint hypermobility. Scores were higher in girls (3.1 +/- 2.4) than boys (2.3 +/- 1.8; P = .004) and decreased with age (P < .001; r = -0.25). Race and body mass index did not impact joint hypermobility prevalence. Beighton scores were not related to abdominal pain or stooling characteristics. Participants with a score of >=4 and >=6 had greater somatization and depression by child report (P = .017 and P = .048, respectively). No association was seen for anxiety. There was no significant association between joint hypermobility and psychosocial distress measures per parent report. Contrary to the adult literature, the prevalence of joint hypermobility does not differ among children with irritable bowel syndrome, functional abdominal pain, or healthy control children. The presence or severity of joint hypermobility does not correlate with abdominal pain or stooling characteristics. Somatization and depression by child report appear to have a relationship with joint hypermobility.