Hypermobility & Common Comorbidities Part 3: Understanding Gastrointestinal Issues in hEDS & HSD

For many people living with hypermobile Ehlers-Danlos syndrome (hEDS) or Hypermobility Spectrum Disorder (HSD), joint pain is only one piece of the puzzle. Gastrointestinal (GI) symptoms are among the most common comorbidities associated with hypermobility and can have a significant impact on quality of life.

Understanding the connection between hypermobility and digestive health can help patients recognize symptoms, seek appropriate evaluation, and receive more comprehensive care.

Why Are GI Issues Common in Hypermobility?

The gastrointestinal tract relies on healthy connective tissue, coordinated muscle contractions, and proper nervous system function to move food efficiently from the esophagus through the intestines.

In people with hEDS and HSD, differences in connective tissue, autonomic nervous system function, and other associated conditions may contribute to digestive symptoms. While not everyone with hypermobility experiences GI problems, they are reported at much higher rates than in the general population.

Common Gastrointestinal Conditions Associated with hEDS & HSD

Several gastrointestinal disorders are more frequently seen in individuals with hypermobility, including:

• Gastroparesis, or delayed stomach emptying
• Constipation
• Irritable Bowel Syndrome (IBS) and other Disorders of Gut-Brain Interaction (DGBIs)
• Small bowel dysmotility, where the small intestine has difficulty moving food effectively
• Eosinophilic Esophagitis (EoE), an inflammatory condition affecting the esophagus
• Gastroesophageal Reflux Disease (GERD)
• Disorders of Gut-Brain Interaction (DGBIs), where communication between the digestive system and nervous system contributes to symptoms
• Organ ptosis, where connective tissue laxity may contribute to organs sitting lower than expected

These conditions can occur individually or alongside one another, making diagnosis and treatment more complex.

Common Symptoms

Digestive symptoms vary widely, but some of the most frequently reported include:

• Nausea
• Bloating
• Heartburn or acid reflux
• Early fullness after eating
• Abdominal discomfort or pain
• Constipation or changes in bowel habits

Because many gastrointestinal disorders share similar symptoms, a thorough evaluation by a healthcare provider is important to determine the underlying cause.

The Role of Mast Cells

Research continues to explore the relationship between mast cell activation disorders (MCAD) and gastrointestinal symptoms in people with hypermobility.

Mast cells are immune cells involved in allergic and inflammatory responses. When they become overactive, they may contribute to symptoms such as abdominal pain, nausea, bloating, diarrhea, and other digestive complaints.

Emerging evidence suggests mast cell dysfunction may play a role in IBS and other gastrointestinal symptoms for some individuals with hEDS and HSD. If symptoms suggest mast cell involvement, discussing further evaluation with your healthcare provider may be appropriate.

Don’t Overlook Small Fiber Neuropathy

Another condition receiving increasing attention is Small Fiber Neuropathy (SFN).

Small nerve fibers help regulate pain, temperature sensation, and autonomic functions—including digestion. Dysfunction of these nerves may contribute to gastrointestinal symptoms as well as other issues commonly experienced in hypermobility, such as burning pain, numbness, dizziness, and autonomic dysfunction.

While research is ongoing, SFN is an important consideration when evaluating persistent gastrointestinal symptoms in individuals with hypermobility.

A Whole-Body Approach to Care

Digestive symptoms are often interconnected with other systems affected by hypermobility, including the nervous system, immune system, and musculoskeletal system. Addressing only one symptom rarely tells the full story.

A multidisciplinary approach may include gastroenterology, physical therapy, nutrition, allergy/immunology, and other specialists depending on each individual’s presentation.

The goal is not simply to treat digestive symptoms, but to understand how they fit into the broader picture of hypermobility and overall health.

The Bottom Line

Gastrointestinal issues are a common and often underrecognized aspect of hypermobile Ehlers-Danlos syndrome (hEDS) and Hypermobility Spectrum Disorder (HSD). Recognizing these symptoms—and understanding their potential connection to connective tissue, the nervous system, and immune function—can help guide more comprehensive evaluation and care.

If you’re living with hypermobility and experiencing persistent digestive symptoms, talk with a healthcare provider familiar with connective tissue disorders. Early recognition and individualized treatment can make a meaningful difference in quality of life.

References

• American Gastroenterological Association. Clinical Practice Update on Gastrointestinal Manifestations and Autonomic or Immune Dysfunction in Hypermobile Ehlers-Danlos Syndrome: Expert Review.
• The Ehlers-Danlos Society. GI & Autoimmune Considerations in Hypermobile Ehlers-Danlos Syndrome.