Hypermobility Score Research Articles

Correlation between hypermobility score and injury rate in artistic gymnastics.

Generalized joint hypermobility (GJH) is suggested as a contributing factor for injuries in young athletes and adults. It is presumed that GJH causes decreased joint stability, thereby increasing the risk of joint and soft tissue injuries during sports activities. The aim of this study was to determine the correlation between the hypermobility score (using the Beighton`s modification of the Carter-Wilkinson criteria of hypermobility) in gymnasts and injury rate, during the period of one year. This study observed 24 artistic gymnasts (11-26 years old), members of Qatar National Team in artistic gymnastics. We examined the Beighton joint hypermobility screen and a seasonal injury survey. The gymnasts characteristics (age, gender) and gymnastics characteristics (training per day and number of years in training artistic gymnastics) and their relations to injury rate were also included. The most common injury was the lower back pain injury, followed by knee, shoulder, hip and ankle injuries. We found strong correlation of number of years gymnastics training and injury rate (P<0.001). There is no significant correlation in the numbers of training hours during one week and hypermobility score to numbers of injuries (P>0.05). According to this study there is no correlation between GJH and injury rate in artistic gymnasts in Qatar. Total training period in gymnastics have greater contribution in injury rate.

Correlation between quantitative pivot shift and generalized joint laxity: a prospective multicenter study of ACL ruptures

PurposeTo investigate whether an increased magnitude of quantitative rotatory knee laxity is associated with a greater level of generalized joint laxity in ACL-injured and contralateral knees.MethodsA total of 103 patients were enrolled across four international centers to undergo anatomic ACL reconstruction. Rotatory knee laxity was evaluated preoperatively, both in the awake state and under anesthesia, using the standardized pivot shift test. Two devices were used to quantify rotatory knee laxity; an inertial sensor, measuring the joint acceleration, and an image analysis system, measuring the lateral compartment translation of the tibia. The presence of generalized joint laxity was determined using the Beighton Hypermobility Score. The correlation between the level of generalized joint laxity and the magnitude of rotatory knee laxity was calculated for both the involved knee and the non-involved knee. Further, patients were dichotomized into low (0–4) or high (5–9) Beighton Score groups. Alpha was set at < 0.05.ResultsNinety-six patients had complete datasets, 83 and 13 in the low and high Beighton Score groups respectively. In anesthetized patients, there was a significant correlation between the degree of Beighton Score and quantitative pivot shift when analyzing the non-involved knee using the image analysis system (r = 0.235, p < 0.05). When analyzing the same knee, multivariate analysis adjusted for meniscal injury, age and gender revealed an increased odds ratio for patients with increased lateral compartment translation to be part of the high Beighton Score group (OR 1.86, 95% CI 1.10–3.17, p < 0.05). No other correlation was significant. When analyzing the dichotomized subgroups, no significant correlations could be established.ConclusionThe findings in this study suggest that there is a weak correlation between generalized joint laxity and the contralateral healthy knee, indicating increased rotatory knee laxity in these patients. Generalized joint laxity does not appear to correlate with rotatory knee laxity in ACL-injured knees.Level of evidenceProspective cohort study; level of evidence, 2.

Impact of Generalized Joint Laxity on Plantar Loading Patterns in Young Females.

Generalized joint laxity is often associated with gait deviations. The aim of this study was to investigate the static and dynamic loading pattern of the foot with increasing joint mobility and to discuss the potential impact of this condition on the plantar loading patterns. Seventy female participants between ages of 18 and 30 were included in this cross-sectional survey. The Beighton-Horan Joint Mobility Index scores were assessed and participants divided into 3 categories: no hypermobility (NH) group, scores 0 to 2; moderate hypermobility (MH) group, scores 3 to 4; distinct hypermobility (DH) group, scores 5 to 9. Pedobarographic analysis was performed both in static and walking conditions. Dynamic foot loading examined in 10 anatomic zones. Contact areas of forefoot, midfoot, and rearfoot were recorded. In the dynamic pedobarographic analysis, individuals with distinct joint hypermobility displayed higher peak pressure and maximum force values under the hallux, compared with other groups ( P < .05). The maximum force value of the second metatarsal was higher in the DH group than in the MH group ( P < .05). Our study results suggest that plantar loading pattern differs with increasing degrees of the hypermobility score. Differences in plantar loading parameters in people with severe joint mobility scores may be useful in interpreting the foot pathologies of these individuals.

0518 TREATMENT OF SLEEP DISORDERED BREATHING IN HYPERMOBILE PATIENTS

Patients with hypermobility syndromes often have difficulty using Positive Airway Pressure (PAP) Therapy for treatment of their Sleep Disordered Breathing. To investigate this, the CPAP titrations of patients with hypermobility were studied in detail. The attended PAP titrations of 19 consecutive patients with a Beighton hypermobility score of 5 or greater at a neurology institute were retrospectively reviewed. Of 19 patients, 6 had Sleep Apnea - Unspecified (Upper Airway Resistance Syndrome) (G47.30) and 13 had Obstructive Sleep Apnea (G47.33). All ± values reflect the standard error of the mean. During titrations, after an initial nadir for scorable hypopneas was achieved, 11 of 19 patients experienced an average increase of 10.24 ± 2.5 in their hypopnea index as pressure was increased. At their hypopnea nadir, 15 of 19 patients’ AHI was 0 and an average Respiratory Effort Related Arousal Index of 38.4 ± 6.7 remained. Example titrations and images of typical airways in hypermobile patients will be presented. 1. In typical CPAP titrations hypopneas and RERAs should generally decrease and eventually plateau as PAP is increased. However, the pattern observed in the titration of these patients with hypermobility is somewhat atypical. 2. In hypermobile patients, the high RERA index at the hypopnea nadir, with subsequent increases in both with increasing pressure, could be explained by the following mechanism: In hypermobile patients, the epiglottis is more flexible than usual, and even though the upper portion of the lower airway can be expanded by PAP, increasing pressure in hypermobile patients could lead to epiglottal closure. 3. Auto-titrating CPAPs currently do not measure RERA’s well, because of their inability to assess EEG arousals, despite having formidable algorithms which can measure changes in airway resistance. Thus, the use of auto-titrating PAP devices may not be effective in the relief of sleep complaints in patients with hypermobility and SDB. 4. This lack of effectiveness could lead to poor compliance with PAP therapy in patients with hypermobility. 5. Thus, patients with hypermobility probably need an attended PAP titration to achieve optional airway patency, and resolution of their complaints related to SDB.

Joint hypermobility syndrome and anxiety disorder: Structural brain correlates

IntroductionJoint hypermobility syndrome/Ehlers Danlos III (JHS/EDS III) is a common, connective tissue condition. This group is over-represented in panic/anxiety disorders and exhibits autonomic abnormalities and heightened interoceptive sensibility. Previous neuroimaging in healthy volunteers with hypermobility has observed differences in key emotional brain regions, notably amygdala and insula.Aims and objective To explore, in a clinical population, the structural brain correlates underpinning the association between JHS/EDS III and anxiety.MethodSeventy participants were divided into four experimental groups: (2 × 2 factor design: presence/absence of hypermobility; presence/absence of anxiety). Hypermobility was assessed using Brighton Criteria. All participants underwent brief tests of autonomic function and interoception. Structural images were obtained using a 1.5 T MRI scanner. Results are reported at whole brain uncorrected significance threshold of P &lt; 0.001.ResultsComparison of grey matter volume revealed increased insular volume in anxious patients with JHS/EDS-III compared to anxious patients without (Fig. 1A, B), correlating with initial peak heart rate on standing. Additionally, amygdala volume correlated with hypermobility score in anxious patients, but not in non-anxious individuals (Fig. 1C, D). Amygdala volume correlated with interoceptive accuracy.ConclusionsThis data implicates amygdala and insula as likely neural substrates mediating clinical relationships between hypermobility syndrome and anxiety, demonstrating the relevance of autonomic and interoceptive influences on this relationship. Further work hopes to explore functional and structural connectivity between these regions in JHS/EDS-III.Disclosure of interestThe authors have not supplied their declaration of competing interest.

A Screening Test to Determine Shoulder Stability in Adolescent Male Rugby Union Players: A Feasibility Study

Objectives: The aim of this study was to investigate the feasibility of a shoulder screening test to predict shoulder stability in adolescent rugby union players. Design: A feasibility study. Methods: Adolescent male rugby union players (n=27) aged 12-18 years were recruited from secondary schools in metropolitan Sydney. Measures of shoulder strength, active joint range of movement and joint hypermobility were recorded. Results: The right shoulder was significantly stronger than the left in extension (mean difference=2.63; t27=-3.38; p=0.002, two-tailed), abduction (mean difference=2.24; t27=-2.42; p=0.023, two-tailed), and internal rotation in neutral (mean difference=1.36; t27=-2.82; p=0.009, two-tailed). No significant differences in strength were found between sides for shoulder flexion and external rotation in neutral. Internal rotation strength was significantly greater in neutral than in 90o abduction but contrary results were found for external rotation. No significant relationship was found between shoulder muscle strength and active shoulder joint range of movement (r=0.05, p=0.81). No significant differences were found between left and right sides for active range of movement. Four participants (14.8%) scored above normal (>4/9) on the Beighton’s Hypermobility Score. There was a moderate, positive correlation between body mass index and average shoulder muscle strength (r=0.40, p=0.04). Conclusion: The protocol used in this study was feasible for both participants and examiners. This screening test could be used to identify potential risk factors for shoulder injury.

A prospective cohort study investigating the effect of generalized joint hypermobility on outcomes after arthroscopic anterior shoulder stabilization

ABSTRACTObjectives: Generalized joint laxity has been proposed as a significant risk factor for failure after arthroscopic anterior shoulder stabilization. The purpose of this study was to prospectively measure joint mobility in patients undergoing arthroscopic anterior shoulder stabilization and to determine whether hypermobility is a risk factor for worse outcomes compared with patients having normal joint mobility.Methods: Patients with anterior shoulder instability were prospectively enrolled. Generalized joint hypermobility was measured using the Beighton Hypermobility Score and the Rowe, UCLA, SANE, SST, and WOSI scores were administered and reported as patient outcomes preoperatively and following arthroscopic anterior shoulder stabilization at 6 weeks, 6 months, 12 months, and 24 months postoperatively. Patients were stratified into two groups based on their Beighton Hypermobility Score, with scores ≥ 4/9 indicative of joint hypermobility.Results: Sixteen patients with joint hypermobility (JH) and 18 non-hypermobile patients (NJH) were enrolled. At baseline, there were no significant differences in demographic characteristics or baseline patient-reported outcomes. Significantly more patients in the NJH group had SLAP tears (n = 10) compared to the JH group (n = 2) (p = .013). At all follow-up times, there were no significant differences between the NJH and JH groups with regard to patient-reported outcome scores (p > .05). In the JH group, 17% of patients reported recurrent instability at two years postoperatively compared to 25% of patients in the NJH group. There was no significant difference in failure rate (p = .67).Conclusion: There was no significant difference in patient-reported outcomes or recurrent instability in patients with versus without joint hypermobility undergoing arthroscopic anterior shoulder stabilization.

Kinematic analysis of hip and knee rotation and other contributors to ballet turnout

ABSTRACTTurnout, or external rotation (ER) of the lower extremities, is essential in ballet. The purpose of this study was to utilise physical examination and a biomechanical method for obtaining functional kinematic data using hip and knee joint centres to identify the relative turnout contributions from hip rotation, femoral anteversion, knee rotation, tibial torsion, and other sources. Ten female dancers received a lower extremity alignment assessment, including passive hip rotation, femoral anteversion, tibial torsion, weightbearing foot alignment, and Beighton hypermobility score. Next, turnout was assessed using plantar pressure plots and three-dimensional motion analysis; participants performed turnout to ballet first position on both a plantar pressure mat and friction-reducing discs. A retro-reflective functional marker motion capture system mapped the lower extremities and hip and knee joint centres. Mean total turnout was 129±15.7° via plantar pressure plots and 135±17.8° via kinematics. Bilateral hip ER during turnout was 49±10.2° (36% of total turnout). Bilateral knee ER during turnout was 41±5.9° (32% of total turnout). Hip ER contribution to total turnout measured kinematically was less than expected compared to other studies, where hip ER was determined without functional kinematic data. Knee ER contributed substantially more turnout than expected or previously reported. This analysis method allows precise assessment of turnout contributors.

Inter- and intra-rater reliabilities of the Beighton Score compared to the Contompasis Score to assess Generalised Joint Hypermobility

AbstractObjectives: Generalized Joint Hypermobility [GJH] is a common connective tissue disorder associated with a range of musculoskeletal complaints. An effective screening tool to assess GJH may influence our understanding and choice of management. Diagnosis is clinical, using tools such as the Beighton Hypermobility Score and the Contompasis Scoring System. The comparable reliability of these tools has not been previously reported. The aim of the present study was to compare the intra- and the inter-rater reliability of the Beighton Score to the Contompasis Score to assess GJH.Methods: This was an observational study assessing 36 pain-free participants; 27 females and nine males; aged 18–32 years. Participants were assessed in random order, by two researchers over two sessions to determine intra- and inter-rater analyses. Intraclass Correlation Coefficient [ICC] and weighted Kappa statistics were used to calculate the level of agreement.Results: The intra- [ICC: 0.71–0.82] and the inter- [ICC: 0.72–0....

Measuring joint hypermobility using the Beighton scale in children with intellectual disability.

To determine the feasibility and reliability of using the 9-point Beighton Hypermobility Score (9-BHS) with youth with intellectual disabilities using a least to most prompting technique. One hundred one youth (5-18 years old) enrolled in the study. Two separate evaluations, separated by 3 to 4 weeks, were performed on 25 participants. Ninety assented to the test, and 85 performed all 9-BHS maneuvers. Scores were not significantly different for age and gender, but participants with Down syndrome had significantly higher scores. Test-retest scores showed 80% to 90% agreement (n = 25). Cohen kappa ranged from moderate (0.41-0.60) to perfect (1.0) for the 9 maneuvers, and an ICC of 0.88 was found for total scores. The results demonstrate that the use of the 9-BHS in youth with intellectual disabilities in the manner described is feasible and reliable.

Inter- and intra-rater reliability of the Beighton Score compared to the Contompasis Score to assess generalised joint hypermobility

Background: Generalised joint hypermobility (GJH) is a common connective tissue disorder associated with a range of musculoskeletal complaints. An effective screening tool to assess GJH may influence our understanding and choice of management. Diagnosis is clinical, using tools such as the Beighton Hypermobility Score and the Contompasis Scoring System. The comparable reliability of these tools has not been previously reported. The aim of the present study was to compare the intra- and inter-rater reliability of the Beighton Score to the Contompasis Score to assess GJH. Methods: This was a randomised observational study assessing 36 pain-free participants: 27 females and nine males, with a mean age of 22.7 years ± 3.71 (range 18 to 32 years). Participants were assessed by two researchers over two sessions to allow for intra- and inter-rater analysis. Intraclass correlation coefficient (ICC) and weighted Kappa statistics were used to calculate the level of agreement. Results: The intra- (ICC=0.71–0.82) and inter-rater (ICC=0.72–0.80) reliability of the Beighton Score is substantial to almost perfect. The Contompasis Score displayed substantial to almost perfect intra-rater (ICC=0.73–0.82) reliability and moderate to substantial inter-rater (ICC=0.58–0.62) reliability. Conclusions: It is hypothesised that in clinical practice the Beighton Score is more appropriate due to greater inter-rater reliability, whereas in a research setting with experienced practitioners, the Contompasis Score would be more appropriate, due to almost perfect intra-rater reliability. Implications: The present study provides an indication of the measurement capabilities of the Beighton and Contompasis Scores, as well as providing a platform for further research.

The effects of talus control foot orthosis in children with flexible pes planus

Fourty children were participated in this study who had been diagnosed as flexible pes planus, and had more than two consecutive radiologic studies. The anteroposterior talocalcaneal angles (APTCA) and lateral talocalcaneal angles (LTTCA), the lateral talometatarsal angles (LTTMA) and the calcaneal pitch (CP) of both feet were measured to evaluate foot alignment. Severe flexible pes planus was diagnosed when Beighton hypermobility score was greater than 4 points and when either of the feet had greater than 10 degrees valgus of resting calcaneal stance position angle and indicators showed greater than 55 degrees in APTCA and LTTCA, greater than 10 degrees in LTTMA, lesser than 10 degrees of CP. Twenty children with flexible flat foot were fitted with a pair of RFO and another 20 children were fitted with TCFO. They were recommended to put on orthosis more than 8 hrs a day, to walk with heel strike at initial contact and reciprocal arm swing to normalize gait pattern. The follow up clinical evaluation with radiologic study was done after 12 months. Result With TCFO, all radiologic indicators changed toward corrective direction than with RFO. There were statistically significant improvements in CP and RCSP in both groups. (p < 0.05) In TCFO group, APTCA, RCSP improved significantly compared with RFO group. Conclusion This study showed that TCFO is effective in the treatment of children with severe flexible pes planus than RFO. The evaluation with long term follow up of radiographic study would be necessary to confirm the therapeutic effect of TCFO in children with pes planus.

Comparison of the nine-point Beighton hypermobility score between males and females

This paper was initially delivered at the Annual Congress of the Biological Sciences Division of the South African Academy for Science and Art, ARC-Plant Protection Research Institute, Roodeplaat, Pretoria, South Africa on 01 October 2010.

Prevalence of radiographic findings associated with hip dysplasia in a population-based cohort of 2081 19-year-old Norwegians

In Norway total joint replacement after hip dysplasia is reported more commonly than in neighbouring countries, implying a higher prevalence of the condition. We report on the prevalence of radiological features associated with hip dysplasia in a population of 2081 19-year-old Norwegians. The radiological measurements used to define hip dysplasia were Wiberg's centre-edge (CE) angle at thresholds of < 20° and < 25°, femoral head extrusion index < 75%, Sharp's angle > 45°, an acetabular depth to width ratio < 250 and the sourcil shape assessed subjectively. The whole cohort underwent clinical examination of their range of hip movement, body mass index (BMI), and Beighton hypermobility score, and were asked to complete the EuroQol (EQ-5D) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). The prevalence of hip dysplasia in the cohort varied from 1.7% to 20% depending on the radiological marker used. A Wiberg's CE angle < 20° was seen in 3.3% of the cohort: 4.3% in women and 2.4% in men. We found no association between subjects with multiple radiological signs indicative of dysplasia and BMI, Beighton score, EQ-5D or WOMAC. Although there appears to be a high prevalence of hip dysplasia among 19-year-old Norwegians, this is dependent on the radiological parameters applied.

A new approach to measure functional stability of the knee based on changes in knee axis orientation

There is a lack of measures that quantify functional knee stability, which is of particular relevance in knee rehabilitation. Therefore, the aim of this study was to investigate the usefulness of knee finite helical axis (FHA) variables in 33 healthy subjects during two different functional tasks; One leg side hop (SH) and Two Leg Squat (TLS), and to investigate correlations of these variables with laxity. Laxity was assessed with a KT-1000 arthrometer and the Beighton Hypermobility Score. Movements were registered with an optical motion capture system. Knee rotation and translation were defined by a six degree of freedom segment model. FHA was calculated for finite steps of 20° knee flexion, based on error simulations. We computed the FHA inclination, the translation along FHA and an FHA Direction Index quantifying directional changes. All variables were repeatable (average ICCs ∼0.97 during TLS and ∼0.83 during SH). The lower functional knee stability in SH was reflected by a significantly higher FHA Direction Index and a larger medio-lateral FHA inclination compared to those in TLS. The superior–inferior inclination was smaller during Landing in SH compared to Take-Off and TLS. Translation along FHA was generally small as expected in healthy subjects. Beighton Hypermobility Score and KT-1000 values had weak but significant correlations with FHA Direction Index and FHA translation, which show that laxity influences the functional knee stability. We conclude that FHA measures were sensitive enough to discriminate between SH and TLS. The next step is to investigate the usability of these measures in subjects with knee injury.

Back mobility and interincisor distance ranges in racially diverse North American healthy children and relationship to generalized hypermobility

BackgroundGiven the dearth of normal values, we conducted a cross-sectional study of North American racially diverse children to determine normal values of interincisor distance and lower spine flexion.MethodsDemographs of 307 children aged 5–17 seeking treatment emergency care were obtained along with interincisor distance measured by incisor tooth-to-tooth gap, lower spine flexion measured by the Schober and modified Schober measurements, popliteal extension, hypermobility (Beighton) score, weight and height.ResultsNormal range of motion values for the Schober was a mean of 14.3 cm (95% confidence interval (CI) was 11.2 to 17. cm) and the mean modified Schober’s was 21.6 cm (95% CI 18.4 cm to 24.8 cm). Retained lumbar lordosis on forward flexion was observed in 33%. Back mobility was associated with body mass index (BMI), popliteal angle, and Beighton score but not sex, race or retained lordosis. The mean interincisor distance measurement was 47 mm (95% CI 35 mm to 60 mm) and was associated with height and BMI but not sex, race, or Beighton score.ConclusionNormal values for lower back range of motion and interincisor distance were obtained which are needed in pediatric rheumatologic clinics and do not significantly vary as to race or sex. Retained lordosis on forward flexion is a normal variant. Hamstring tightness, hypermobility and BMI need to be considered when ascertaining back mobility.

Is joint hypermobility associated with vesico‐ureteral reflux? An assessment of 50 patients

To assess whether there is an increased prevalence of joint hypermobility in patients with vesico-ureteric reflux (VUR). We studied 50 patients with primary VUR and matched controls drawn from a reference population. Joint mobility was assessed using the Bulbena hypermobility score. We identified significantly more patients with VUR with generalized joint hypermobility than controls (24% vs 6.7%, P= 0.007). Our findings confirm our clinical observation of an increased rate of joint hypermobility in patients with VUR. We speculate that an altered composition of the connective tissue may contribute to the severity of the (pre-existing) VUR phenotype.

Tradução e validação do The five part questionnaire for identifying hypermobility para a língua portuguesa do Brasil

Joint hypermobility (JH) is an inherited clinical condition with increased joint elasticity in passive movements. In the general population, its frequency, which can be estimated through specific methods, such as the nine-point Beighton hypermobility score (Beighton score) and the self-reported five-part questionnaire for identifying hypermobility (five-part questionnaire), ranges from 10% to 20%. To validate the Portuguese version of the five-part questionnaire and to determine its sensitivity and specificity when compared with the Beighton score for diagnosing JH. The five-part questionnaire for identifying hypermobility was translated into Portuguese and applied to 2,523 Brazilian university students. Then, a sample with 394 randomly selected students was evaluated by use of the Beighton score, aiming at establishing the JH diagnosis. Finally, the two methods were statistically compared. The JH frequency was 37.01% when using the five-part questionnaire, and 34% when using the Beighton score. Considering sex, the JH frequencies according to the five-part questionnaire and Beighton score were 43.54% and 44.26% in females, and 28.44% and 16% in males, respectively. The sensitivity of the self-reported questionnaire was 70.9% and its specificity was 77.4%, with an area under the receiver operating characteristic (ROC) curve of 0.786. JH is frequent in Brazilian university students, and more common in women. The self-reported five-part questionnaire for JH identification, translated into Portuguese and validated, was an effective method when compared with the Beighton score for identifying JH.

M1168 Gastro-Oesophageal Mechanisms of Recurrent Postprandial Vomiting in Young Patients With Joint Hypermobility Syndrome and Autonomic Dysfunction

Introduction We have recently demonstrated a high prevalence of functional GI disorders in patients with joint hypermobility syndrome.1 These patients frequently have autonomic nerves dysfunction and may present with recurrent vomiting, severe dyspepsia and constipation. We aimed to characterise the OGJ mechanisms underlying recurrent postprandial vomiting in a series of consecutive patients with joint hypermobility syndrome and/or autonomic dysfunction. Methods Twelve patients (mean age=25.5 years, 9 females, 3 males) referred for gastro-oesophageal motility testing due to recurrent postprandial vomiting were studied during fasting and postprandial periods using combined high-resolution manometry-impedance. Eating disorders, neurologic and other organic gastrointestinal disorders were previously excluded. Median duration of postprandial vomiting was 17 months. Using Beighton Hypermobility Score, 7/12 patients were diagnosed with Joint Hypermobility Syndrome (JHS). In five of these patients we found autonomic dysfunction symptoms. Combined stationary HRM-impedance (Sandhill Scientific) was performed in semirecumbent position. The protocol included 10 single wet swallows, 2 multiple rapid swallows sequences, a semisolid standard meal followed by 30 min postprandial monitoring. Chicago Classification 2009 was used to classify oesophageal motility disorders. Results Hiatus hernia was diagnosed in 4/12 patients. Normal oesophageal motility was observed in 6/12 patients and the remaining patients had intermittent hypotensive peristalsis. All patients vomited after the standard meal. Nausea preceding vomiting was present in only 5/12 patients. Aerophagia, objectively detected by impedance, was a major feature, found in 8/12 patients. However, only 4 patients had an impedance pattern of belching-liquid regurgitation. The majority of patients had objective abdominal straining (detected with HRM as abrupt, low amplitude, simultaneous increase in gastro-oesophageal pressure) followed by liquid intra-oesophageal retrograde flow with high proximal extent. Conclusion JHS was present in a significant proportion of these young patients with recurrent postprandial vomiting. Aerophagia was a significant consistent finding in these patients. We hypothesise that patients with JHS and oesophago-gastro-intestinal involvement may perceive early postprandial mild gastric discomfort (probably due to liquid accumulation in the gastric cardiac region) and develop an aerophagic behaviour to alleviate their discomfort by belching. Subsequently, straining to belch is associated with vomiting.

PTH-049 Gastro-oesophageal mechanisms of recurrent postprandial vomiting in young patients with joint hypermobility syndrome and autonomic dysfunction

<h3>Introduction</h3> We have recently demonstrated a high prevalence of functional GI disorders in patients with joint hypermobility syndrome.1 These patients frequently have autonomic nerves dysfunction and may present with recurrent vomiting, severe dyspepsia and constipation. We aimed to characterise the OGJ mechanisms underlying recurrent postprandial vomiting in a series of consecutive patients with joint hypermobility syndrome and/or autonomic dysfunction. <h3>Methods</h3> Twelve patients (mean age=25.5 years, 9 females, 3 males) referred for gastro-oesophageal motility testing due to recurrent postprandial vomiting were studied during fasting and postprandial periods using combined high-resolution manometry-impedance. Eating disorders, neurologic and other organic gastrointestinal disorders were previously excluded. Median duration of postprandial vomiting was 17 months. Using Beighton Hypermobility Score, 7/12 patients were diagnosed with Joint Hypermobility Syndrome (JHS). In five of these patients we found autonomic dysfunction symptoms. Combined stationary HRM-impedance (Sandhill Scientific) was performed in semirecumbent position. The protocol included 10 single wet swallows, 2 multiple rapid swallows sequences, a semisolid standard meal followed by 30 min postprandial monitoring. Chicago Classification 2009 was used to classify oesophageal motility disorders. <h3>Results</h3> Hiatus hernia was diagnosed in 4/12 patients. Normal oesophageal motility was observed in 6/12 patients and the remaining patients had intermittent hypotensive peristalsis. All patients vomited after the standard meal. Nausea preceding vomiting was present in only 5/12 patients. Aerophagia, objectively detected by impedance, was a major feature, found in 8/12 patients. However, only 4 patients had an impedance pattern of belching-liquid regurgitation. The majority of patients had objective abdominal straining (detected with HRM as abrupt, low amplitude, simultaneous increase in gastro-oesophageal pressure) followed by liquid intra-oesophageal retrograde flow with high proximal extent. <h3>Conclusion</h3> JHS was present in a significant proportion of these young patients with recurrent postprandial vomiting. Aerophagia was a significant consistent finding in these patients. We hypothesise that patients with JHS and oesophago-gastro-intestinal involvement may perceive early postprandial mild gastric discomfort (probably due to liquid accumulation in the gastric cardiac region) and develop an aerophagic behaviour to alleviate their discomfort by belching. Subsequently, straining to belch is associated with vomiting.