P297 Altered diet in hypermobile ehlers danlos syndromeis predicted by upper gastrointestinal disorders and psychopathology

Introduction

Disorders of Gut-Brain Interaction (DGBI) may be associated with dietary alterations in Hypermobile Ehlers Danlos Syndrome (hEDS), yet the dietary behaviours and factors that influence them remain unknown.

Methods

Cross sectional study from August ‘21 to January ‘22. hEDS patients from the charity organisation Ehlers-Danlos Support UK and tertiary Neurogastroenterology clinics completed questionnaires quantifying dietary behaviours, eating patterns, DGBI (Rome IV), Visceral Sensitivity Index (VSI) - a measure of gastrointestinal (GI) specific anxiety, Composite Autonomic Symptom Score, Gastrointestinal Symptom Rating Scale (GSRS) and the Nine Item Avoidant/Restrictive Food Intake Disorder Screen (NIAS) for Avoidant Restrictive Food Intake Disorder (ARFID). We used stepwise logistic regression to ascertain which variables predicted an altered diet.

Results

681 participants responded (median: 39 years (range; 16-76), 95% female). 49.3%(n=335) reported irregular eating patterns, which was predominantly attributed to symptoms(75.8%). 62.0% of participants regularly skip meals and this was predicted by chronic nausea(OR: 1.9; 95% CI: 1.3-2.8; p<0.001) and functional dyspepsia(OR: 1.8; 95% CI: 1.2-2.5; p=0.002). 62.1%(n=423) described altering their diet in the last year. GI symptoms(57.1%) and allergies/food intolerances(41%) were the most common reasons for altering diet. The greatest improvement was reported with a dairy free diet(78.7%) followed by gluten-free diet(74.5%) and low FODMAP diet(62.1%). 31.7% of those who altered their diet required artificial nutrition - oral supplementation(22.3%), enteral nutrition(12.9%) or parenteral nutrition(10.5%). Altered diet was predicted by; functional heartburn(p=0.02), functional dyspepsia(p=0.0004), belching disorders(p=0.006) and chronic nausea(p=0.02); and by higher scores on VSI(p=0.01), GSRS(p=0.04) and NIAS(p=0.04). 30.2% of patients (n=206) screened positive for ARFID of whom 77.2% reported no history of an eating disorder. The most common sub-types of ARFID related to lack of appetite(60.5%) and fear that food will trigger GI symptoms(56.7%).

Conclusions

Dietary behaviour among hEDS patients is frequently altered and influenced by the presence of foregut DGBI, therefore upper GI symptoms should primarily be targeted to improve altered diet and reduce the need for artificial nutrition. The association of altered diet with GI specific anxiety provides a compelling case for psychological support in dietary interventions.