Gastroenterol Res

Gastroenterology Research, ISSN 1918-2805 print, 1918-2813 online, Open Access

Article copyright, the authors; Journal compilation copyright, Gastroenterol Res and Elmer Press Inc

Journal website http://www.gastrores.org

Original Article

Volume 12, Number 1, February 2019, pages 27-36

Joint Hypermobility Syndrome Affects Response to a Low Fermentable Oligosaccharide, Disaccharide, Monosaccharide and Polyol Diet in Irritable Bowel Syndrome Patients: A Retrospective Study

**Table 1.** Descriptive Characteristics
Variables	Total N (%)	JHS	IBS
The baseline scores and duration are non-normally distributed according to Kolmogorov’s test and hence median is preferred.
Gender
Females	130 (78.8)	34 (97.1)	96 (73.8)	0.003	35 (100.0)	67 (100.0)	28 (44.4)	< 0.0001
Males	35 (21.2)	1 (2.9)	34 (26.2)		0 (0.0)	0 (0.0)	35 (55.6)
Age (years)
18 ≤ age < 35	52 (32.5)	17 (48.6)	35 (28.0)	0.035	9 (25.7)	26 (40.0)	17 (28.3)	0.269
35 ≤ age < 50	56 (35.0)	12 (34.3)	44 (35.2)		17 (48.6)	16 (24.6)	23 (38.3)
50 ≤ age < 65	36 (22.5)	6 (17.1)	30 (24.0)		5 (14.3)	16 (24.6)	15 (25.0)
65 ≤ age	16 (10.0)	0 (0.0)	16 (12.8)		4 (11.4)	7 (10.8)	5 (8.3)
IBS subtypes
IBS-C	67 (40.6)	11 (31.4)	24 (18.5)	0.074	---	---	---	---
IBS-D	35 (21.2)	16 (45.7)	51 (29.2)		---	---	---
IBS-M	63 (38.2)	8 (22.9)	55 (42.3)		---	---	---
JHS
Yes	35 (21.2)	---	---	---	11 (31.4)	16 (23.9)	8 (12.7)	0.074
No	130 (78.8)	---	---		24 (68.6)	51 (76.1)	55 (87.3)
Positive lactose breath tests
No	67 (65.0)	17 (85.0)	50 (60.2)	0.037	13 (59.1)	24 (60.0)	30 (73.2)	0.371
Yes	36 (35.0)	3 (15.0)	33 (39.8)		9 (40.9)	16 (40.0)	11 (26.8)
Positive fructose breath tests
No	48 (64.9)	8 (53.3)	40 (67.8)	0.298	9 (60.0)	19 (63.3)	20 (69.0)	0.818
Yes	26 (35.1)	7 (46.7)	19 (32.2)		6 (40.0)	11 (36.7)	9 (31.0)
FODMAP training
Individual	66 (40.0)	11 (31.4)	55 (42.3)	0.244	7 (20.0)	20 (29.9)	39 (61.9)	< 0.0001
Group	99 (60.0)	24 (68.6)	75 (57.7)		28 (80.0)	47 (70.1)	24 (38.1)
	Median (IQR)			Mann-Whitney P-value				Mann-Whitney P-value
Baseline scores
Pain	3.8 (2.5 - 4.0)	3.8 (3.3 - 5.0)	3.5 (2.5 - 3.8)	0.011	3.8 (2.5 - 4.8)	3.8 (2.5 - 3.8)	3.3 (2.5 - 4.0)	0.122
Bloating	3.8 (3.1 - 4.9)	3.8 (3.5 - 5.0)	3.8 (2.9 - 4.5)	0.149	3.8 (3.8 - 5.0)	3.8 (3.3 - 5.0)	3.8 (2.5 - 4.5)	0.128
Constipation	0.5 (0.0 - 1.5)	1.0 (0.0 - 3.0)	0.5 (0.0 - 1.3)	0.329	1.0 (1.0 - 5.0)	0.0 (0.0 - 0.5)	1.0 (0.0 - 2.0)	< 0.0001
Diarrhea	1.0 (0.8 - 3.0)	1.0 (0.0 - 3.0)	1.0 (1.0 - 3.0)	0.110	0.0 (0.0 - 0.0)	1.0 (1.0 - 3.0)	2.5 (1.0 - 3.5)	< 0.0001
Average	2.4 (2.1 - 2.9)	2.8 (2.3 - 3.1)	2.4 (2.0 - 2.8)	0.023	2.4 (2.1 - 2.9)	2.4 (2.0 - 2.8)	2.6 (2.1 - 3.2)	0.102
Duration of FODMAP diet (days)	63 (56 - 83)	63 (56 - 84)	63 (56 - 83)	0.142	63 (56 - 84)	63 (49 - 71)	70 (56 - 87)	0.020

Table 1. Descriptive Characteristics

Variables

Total N (%)

JHS

IBS

JHS (n = 35)

Non-JHS (n = 130)

χ² P-value

IBS-C (n = 67)

IBS-D (n = 35)

IBS-M (n = 63)

χ² P-value

The baseline scores and duration are non-normally distributed according to Kolmogorov’s test and hence median is preferred.

Gender

Females

130 (78.8)

34 (97.1)

96 (73.8)

0.003

35 (100.0)

67 (100.0)

28 (44.4)

< 0.0001

Males

35 (21.2)

1 (2.9)

34 (26.2)

0 (0.0)

35 (55.6)

Age (years)

18 ≤ age < 35

52 (32.5)

17 (48.6)

35 (28.0)

0.035

9 (25.7)

26 (40.0)

17 (28.3)

0.269

35 ≤ age < 50

56 (35.0)

12 (34.3)

44 (35.2)

17 (48.6)

16 (24.6)

23 (38.3)

50 ≤ age < 65

36 (22.5)

6 (17.1)

30 (24.0)

5 (14.3)

16 (24.6)

15 (25.0)

65 ≤ age

16 (10.0)

0 (0.0)

16 (12.8)

4 (11.4)

7 (10.8)

5 (8.3)

IBS subtypes

IBS-C

67 (40.6)

11 (31.4)

24 (18.5)

0.074

---

IBS-D

35 (21.2)

16 (45.7)

51 (29.2)

---

IBS-M

63 (38.2)

8 (22.9)

55 (42.3)

---

JHS

Yes

35 (21.2)

---

11 (31.4)

16 (23.9)

8 (12.7)

0.074

130 (78.8)

---

24 (68.6)

51 (76.1)

55 (87.3)

Positive lactose breath tests

67 (65.0)

17 (85.0)

50 (60.2)

0.037

13 (59.1)

24 (60.0)

30 (73.2)

0.371

Yes

36 (35.0)

3 (15.0)

33 (39.8)

9 (40.9)

16 (40.0)

11 (26.8)

Positive fructose breath tests

48 (64.9)

8 (53.3)

40 (67.8)

0.298

9 (60.0)

19 (63.3)

20 (69.0)

0.818

Yes

26 (35.1)

7 (46.7)

19 (32.2)

6 (40.0)

11 (36.7)

9 (31.0)

FODMAP training

Individual

66 (40.0)

11 (31.4)

55 (42.3)

0.244

7 (20.0)

20 (29.9)

39 (61.9)

< 0.0001

Group

99 (60.0)

24 (68.6)

75 (57.7)

28 (80.0)

47 (70.1)

24 (38.1)

Median (IQR)

Mann-Whitney P-value

Baseline scores

Pain

3.8 (2.5 - 4.0)

3.8 (3.3 - 5.0)

3.5 (2.5 - 3.8)

0.011

3.8 (2.5 - 4.8)

3.8 (2.5 - 3.8)

3.3 (2.5 - 4.0)

0.122

Bloating

3.8 (3.1 - 4.9)

3.8 (3.5 - 5.0)

3.8 (2.9 - 4.5)

0.149

3.8 (3.8 - 5.0)

3.8 (3.3 - 5.0)

3.8 (2.5 - 4.5)

0.128

Constipation

0.5 (0.0 - 1.5)

1.0 (0.0 - 3.0)

0.5 (0.0 - 1.3)

0.329

1.0 (1.0 - 5.0)

0.0 (0.0 - 0.5)

1.0 (0.0 - 2.0)

< 0.0001

Diarrhea

1.0 (0.8 - 3.0)

1.0 (0.0 - 3.0)

1.0 (1.0 - 3.0)

0.110

0.0 (0.0 - 0.0)

1.0 (1.0 - 3.0)

2.5 (1.0 - 3.5)

< 0.0001

Average

2.4 (2.1 - 2.9)

2.8 (2.3 - 3.1)

2.4 (2.0 - 2.8)

0.023

2.4 (2.1 - 2.9)

2.4 (2.0 - 2.8)

2.6 (2.1 - 3.2)

0.102

Duration of FODMAP diet (days)

63 (56 - 83)

63 (56 - 84)

63 (56 - 83)

0.142

63 (56 - 84)

63 (49 - 71)

70 (56 - 87)

0.020

**Table 2.** Mixed Model Results for Each Symptom
	Pain	Bloating	Diarrhea	Constipation	Average score
JHS # time
No # post low FODMAP diet	-0.94	< 0.0001	-1.23	< 0.0001	-0.84	< 0.0001	0.81	< 0.0001	-0.55	< 0.0001
Yes # pre low FODMAP diet	0.70	0.028	0.48	0.128	-0.48	0.151	-0.17	0.597	0.14	0.467
Yes # post low FODMAP diet	-0.77	0.064	-1.07	0.009	-1.3	0.003	0.60	0.154	-0.63	0.009
IBS type # time
IBS-D # post low FODMAP diet	0.22	0.225	0.41	0.057	-0.37	0.102	-0.65	0.003	-0.10	0.449
IBS-C # pre low FODMAP diet	0.06	0.064	0.27	0.327	-2.03	< 0.0001	1.96	< 0.0001	0.06	0.686
IBS-C # post low FODMAP diet	0.05	0.049	0.33	0.221	-0.99	< 0.0001	-0.02	0.943	-0.16	0.319
IBS-M # pre low FODMAP diet	-0.07	-0.073	-0.04	0.835	0.18	0.416	0.98	< 0.0001	0.26	0.037
IBS-M # post low FODMAP diet	0	omitted	0	omitted	0	omitted	0	omitted	0	omitted
JHS #IBS Type # time
Yes # IBS-C # pre low FODMAP diet	0.06	0.912	-0.17	0.735	0.46	0.388	0.83	0.109	0.29	0.326
Yes # IBS-C # post low FODMAP diet	0.74	0.153	0.29	0.571	0.34	0.529	1.10	0.033	0.30	0.030
Yes # IBS-M # pre low FODMAP diet	-0.97	0.067	-0.75	0.152	0.91	0.097	1.58	0.003	0.19	0.535
Yes # IBS-M # post low FODMAP diet	-0.92	0.085	-0.65	0.213	-0.34	0.540	1.07	0.044	-0.21	0.498
Constant	3.31	< 0.0001	3.63	< 0.0001	1.81	< 0.0001	0.20	0.200	2.32	< 0.0001
F test	< 0.0001	< 0.0001	< 0.0001	< 0.0001	< 0.0001

Table 2. Mixed Model Results for Each Symptom

Pain

Bloating

Diarrhea

Constipation

Average score

beta

JHS # time

No # post low FODMAP diet

-0.94

< 0.0001

-1.23

< 0.0001

-0.84

< 0.0001

0.81

< 0.0001

-0.55

< 0.0001

Yes # pre low FODMAP diet

0.70

0.028

0.48

0.128

-0.48

0.151

-0.17

0.597

0.14

0.467

Yes # post low FODMAP diet

-0.77

0.064

-1.07

0.009

-1.3

0.003

0.60

0.154

-0.63

0.009

IBS type # time

IBS-D # post low FODMAP diet

0.22

0.225

0.41

0.057

-0.37

0.102

-0.65

0.003

-0.10

0.449

IBS-C # pre low FODMAP diet

0.06

0.064

0.27

0.327

-2.03

< 0.0001

1.96

< 0.0001

0.06

0.686

IBS-C # post low FODMAP diet

0.05

0.049

0.33

0.221

-0.99

< 0.0001

-0.02

0.943

-0.16

0.319

IBS-M # pre low FODMAP diet

-0.07

-0.073

-0.04

0.835

0.18

0.416

0.98

< 0.0001

0.26

0.037

IBS-M # post low FODMAP diet

omitted

JHS #IBS Type # time

Yes # IBS-C # pre low FODMAP diet

0.06

0.912

-0.17

0.735

0.46

0.388

0.83

0.109

0.29

0.326

Yes # IBS-C # post low FODMAP diet

0.74

0.153

0.29

0.571

0.34

0.529

1.10

0.033

0.30

0.030

Yes # IBS-M # pre low FODMAP diet

-0.97

0.067

-0.75

0.152

0.91

0.097

1.58

0.003

0.19

0.535

Yes # IBS-M # post low FODMAP diet

-0.92

0.085

-0.65

0.213

-0.34

0.540

1.07

0.044

-0.21

0.498

Constant

3.31

< 0.0001

3.63

< 0.0001

1.81

< 0.0001

0.20

0.200

2.32

< 0.0001

F test

< 0.0001

**Table 3.** Mean Differences Post vs. Pre Low FODMAP Diet per Variables JHS, IBS, Time Point and JHS # IBS Type
	Pain	Bloating	Diarrhea	Constipation	Average score
P < 0.05; P < 0.01; **P < 0.001.
JHS
No	-0.85 (-1.06, -0.64)***	-1.38 (-1.76, -0.99)	-1.06 (-1.27, -0.84)***	-1.69 (-2.09, -1.29)	-0.68 (-0.88, -0.47)***	-1.12 (-1.49, -0.75)	-0.39 (-0.59, -0.20)***	-0.70 (-1.06, -0.35)	-0.74 (-0.87, -0.62)***	- 2.11 (-2.54, -1.68)
Yes	-1.13 (-1.53, -0.74)***	-1.89 (-2.69, -1.09)	-1.19 (-1.59, -0.79)***	-1.96 (-2.77, -1.15)	-1.12 (-1.50, -0.73)***	-1.91 (-2.71, -1.10)	-0.51 (-0.87, -0.15)**	-0.93 (-1.63, -0.23)	-0.99 (-1.21, -0.76)***	-2.87 (-3.83, -1.92)
IBS
IBS-C	-0.88 (-1.29, -0.47)***	-1.03 (-1.54, -0.52)	-1.10 (-1.51, -0.68)***	-1.26 (-1.78, -0.73)	0.14 (-0.26, 0.55)	0.17 (-0.31, 0.65)	-1.05 (-1.42, -0.68)***	-1.35 (-1.88, -0.81)	-0.76 (-0.94, -0.57)***	-1.47 (-2.01, -0.92)
IBS-D	-0.98 (-1.31, -0.66)***	-2.01 (-2.84, -1.19)	-0.98 (-1.31, -0.65)***	-1.98 (-2.80, -1.17)	-1.20 (-1.51, -0.88)***	-2.51 (-3.41, -1.61)	0.14 (-0.15, 0.44)	0.32 (-0.34, 0.99)	-0.72 (-0.96, -0.49)***	-2.70 (-3.63, -1.77)
IBS-M	-1.11 (-1.53, -0.68)***	-1.28 (-1.82, -0.74)	-1.30 (-1.73, -0.86)***	-1.48 (-2.04, -0.92)	-1.64 (-2.05, -1.22)***	-1.94 (-2.54, -1.33)	-0.45 (-0.84, -0.06)*	-0.57 (-1.07, -0.07)	-1.12 (-1.37, -0.88)***	-2.26 (-2.90, -1.63)
Post-pre low FODMAP (time)	-0.99 (-1.22, -0.77)***	-1.34 (-1.68, -1.01)	-1.12 (-1.35, -0.90)***	-1.50 (-1.85, -1.16)	-0.90 (-1.12, -0.68)***	-1.24 (-1.58, -0.91)	-0.45 (-0.66, -0.25)***	-0.67 (-0.99, -0.36)	-0.87 (-0.99, -0.74)***	-2.05 (-2.42, -1.67)
JHS # IBS type
Yes # IBS-C	-0.81 (-1.49, -0.13)*	-2.62 (-4.31, -0.93)	-1.02 (-1.71, -0.33)**	-1.75 (-3.19, -0.32)	0.09 (-0.57, 0.76)	0.16 (-1.02, 1.35)	-0.93 (-1.55, -0.31)**	-1.78 (-3.22, -0.34)	-0.67 (-1.06, -0.28)**	-2.03 (-3.53, -0.52)
Yes # IBS-D	-1.25 (-1.82,-0.69)***	-1.16 (-2.23, -0.09)	-1.14 (-1.71, -0.57)***	-1.96 (-3.17, -0.74)	-1.19 (-1.74, -0.64)***	-2.11 (-3.36, -0.86)	0.13 (-0.39, 0.64)	0.24 (-0.74, 1.22)	-0.86 (-1.19, -0.54)***	-2.62 (-3.99, -1.24)
Yes # IBS-M	-1.34 (-2.14, -0.55)**	-2.33 (-4.25, -0.42)	-1.41 (-2.21, -0.60)**	-2.41 (-4.36, -0.47)	-2.25 (-3.03, -1.47)***	-4.00 (-6.66, -1.35)	-0.72 (-1.44, 0.01)	-1.37 (-2.96, 0.22)	-1.43 (-1.89, -0.97)***	-4.33 (-7.15, -1.52)
No # IBS-C	-0.96 (-1.42,-0.50)***	-1.66 (-2.60, -0.72)	-1.17 (-1.63, -0.70)***	-2.00 (-3.00, -1.01)	0.20 (-0.25, 0.65)	0.35 (-0.46, 1.16)	-1.17 (-1.59, -0.75)***	-2.23 (-3.27, -1.19)	-0.77 (-1.04, -0.51)***	-2.34 (-3.40, -1.29)
No # IBS-D	-0.72 (-1.03, -0.40)***	-1.25 (-1.85, -0.64)	-0.82 (-1.14, -0.50)***	-1.41 (-2.02, -0.79)	-1.21 (-1.51, -0.90)***	-2.14 (-2.84, -1.45)	0.16 (-0.13, 0.45)	0.31 (-0.24, 0.86)	-0.65 (-0.83, -0.47)***	-1.96 (-2.63, -1.29)
No # IBS-M	-0.87 (-1.18, -0.57)***	-1.51 (-2.11, -0.91)	-1.19 (-1.49, -0.88)***	-2.03 (-2.69, -1.38)	-1.02 (-1.32, -0.72)***	-1.81 (-2.45, -1.18)	-0.18 (-0.45, 0.10)	-0.33 (-0.87, 0.20)	-0.81 (-0.99, -0.64)***	-2.46 (-3.17, -1.76)

Table 3. Mean Differences Post vs. Pre Low FODMAP Diet per Variables JHS, IBS, Time Point and JHS # IBS Type

Pain

Bloating

Diarrhea

Constipation

Average score

Contrast (95% CI)

SMD (95% CI)

Contrast (95% CI)

SMD (95% CI)

Contrast (95% CI)

SMD (95% CI)

Contrast (95% CI)

SMD (95% CI)

Contrast (95% CI)

SMD (95% CI)

*P < 0.05; **P < 0.01; ***P < 0.001.

JHS

-0.85 (-1.06, -0.64)***

-1.38 (-1.76, -0.99)

-1.06 (-1.27, -0.84)***

-1.69 (-2.09, -1.29)

-0.68 (-0.88, -0.47)***

-1.12 (-1.49, -0.75)

-0.39 (-0.59, -0.20)***

-0.70 (-1.06, -0.35)

-0.74 (-0.87, -0.62)***

- 2.11 (-2.54, -1.68)

Yes

-1.13 (-1.53, -0.74)***

-1.89 (-2.69, -1.09)

-1.19 (-1.59, -0.79)***

-1.96 (-2.77, -1.15)

-1.12 (-1.50, -0.73)***

-1.91 (-2.71, -1.10)

-0.51 (-0.87, -0.15)**

-0.93 (-1.63, -0.23)

-0.99 (-1.21, -0.76)***

-2.87 (-3.83, -1.92)

IBS

IBS-C

-0.88 (-1.29, -0.47)***

-1.03 (-1.54, -0.52)

-1.10 (-1.51, -0.68)***

-1.26 (-1.78, -0.73)

0.14 (-0.26, 0.55)

0.17 (-0.31, 0.65)

-1.05 (-1.42, -0.68)***

-1.35 (-1.88, -0.81)

-0.76 (-0.94, -0.57)***

-1.47 (-2.01, -0.92)

IBS-D

-0.98 (-1.31, -0.66)***

-2.01 (-2.84, -1.19)

-0.98 (-1.31, -0.65)***

-1.98 (-2.80, -1.17)

-1.20 (-1.51, -0.88)***

-2.51 (-3.41, -1.61)

0.14 (-0.15, 0.44)

0.32 (-0.34, 0.99)

-0.72 (-0.96, -0.49)***

-2.70 (-3.63, -1.77)

IBS-M

-1.11 (-1.53, -0.68)***

-1.28 (-1.82, -0.74)

-1.30 (-1.73, -0.86)***

-1.48 (-2.04, -0.92)

-1.64 (-2.05, -1.22)***

-1.94 (-2.54, -1.33)

-0.45 (-0.84, -0.06)*

-0.57 (-1.07, -0.07)

-1.12 (-1.37, -0.88)***

-2.26 (-2.90, -1.63)

Post-pre low FODMAP (time)

-0.99 (-1.22, -0.77)***

-1.34 (-1.68, -1.01)

-1.12 (-1.35, -0.90)***

-1.50 (-1.85, -1.16)

-0.90 (-1.12, -0.68)***

-1.24 (-1.58, -0.91)

-0.45 (-0.66, -0.25)***

-0.67 (-0.99, -0.36)

-0.87 (-0.99, -0.74)***

-2.05 (-2.42, -1.67)

JHS # IBS type

Yes # IBS-C

-0.81 (-1.49, -0.13)*

-2.62 (-4.31, -0.93)

-1.02 (-1.71, -0.33)**

-1.75 (-3.19, -0.32)

0.09 (-0.57, 0.76)

0.16 (-1.02, 1.35)

-0.93 (-1.55, -0.31)**

-1.78 (-3.22, -0.34)

-0.67 (-1.06, -0.28)**

-2.03 (-3.53, -0.52)

Yes # IBS-D

-1.25 (-1.82,-0.69)***

-1.16 (-2.23, -0.09)

-1.14 (-1.71, -0.57)***

-1.96 (-3.17, -0.74)

-1.19 (-1.74, -0.64)***

-2.11 (-3.36, -0.86)

0.13 (-0.39, 0.64)

0.24 (-0.74, 1.22)

-0.86 (-1.19, -0.54)***

-2.62 (-3.99, -1.24)

Yes # IBS-M

-1.34 (-2.14, -0.55)**

-2.33 (-4.25, -0.42)

-1.41 (-2.21, -0.60)**

-2.41 (-4.36, -0.47)

-2.25 (-3.03, -1.47)***

-4.00 (-6.66, -1.35)

-0.72 (-1.44, 0.01)

-1.37 (-2.96, 0.22)

-1.43 (-1.89, -0.97)***

-4.33 (-7.15, -1.52)

No # IBS-C

-0.96 (-1.42,-0.50)***

-1.66 (-2.60, -0.72)

-1.17 (-1.63, -0.70)***

-2.00 (-3.00, -1.01)

0.20 (-0.25, 0.65)

0.35 (-0.46, 1.16)

-1.17 (-1.59, -0.75)***

-2.23 (-3.27, -1.19)

-0.77 (-1.04, -0.51)***

-2.34 (-3.40, -1.29)

No # IBS-D

-0.72 (-1.03, -0.40)***

-1.25 (-1.85, -0.64)

-0.82 (-1.14, -0.50)***

-1.41 (-2.02, -0.79)

-1.21 (-1.51, -0.90)***

-2.14 (-2.84, -1.45)

0.16 (-0.13, 0.45)

0.31 (-0.24, 0.86)

-0.65 (-0.83, -0.47)***

-1.96 (-2.63, -1.29)

No # IBS-M

-0.87 (-1.18, -0.57)***

-1.51 (-2.11, -0.91)

-1.19 (-1.49, -0.88)***

-2.03 (-2.69, -1.38)

-1.02 (-1.32, -0.72)***

-1.81 (-2.45, -1.18)

-0.18 (-0.45, 0.10)

-0.33 (-0.87, 0.20)

-0.81 (-0.99, -0.64)***

-2.46 (-3.17, -1.76)