Connective tissue disorders and the gut

Gastrointestinal (GI) symptoms are common in both inflammatory and non-inflammatory connective tissue disorders and can involve any part of the GI tract from mouth to anus. Dysphagia, gastro-oesophageal reflux, nausea, vomiting, abdominal pain and changes in bowel habit are common symptoms and usually arise from GI dysmotility and altered visceral sensitivity. In scleroderma, sensorimotor dysfunction is pronounced and can result in complications such as Barrett's oesophagus, gastroparesis, small intestinal bacterial overgrowth, malabsorption and malnutrition, with an associated reduction in survival. Treatment is aimed at symptom control and prevention of complications. In hypermobile Ehlers–Danlos syndrome, symptoms are often caused by functional GI disorders such as functional dyspepsia or irritable bowel syndrome; these can also be secondary to associated co-morbidities (e.g. chronic pain, anxiety, postural tachycardia syndrome, opioid use). The patho-aetiology of these conditions appears to be more related to sensory disturbances than dysmotility, although the latter can be present particularly in patients with co-morbid postural tachycardia syndrome. A holistic approach to management must be taken to address all contributing factors, especially anxiety, diet and medication adverse effects.