Chronic Cough and Digestive Issues in HEDS Beyond Gastroparesis

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Living with Hypermobile Ehlers-Danlos Syndrome (HEDS) often means managing a complex mix of symptoms. Many people with HEDS experience digestive problems like chronic cough, reflux, and alternating constipation and diarrhea. These symptoms are frequently linked to gastroparesis, a condition where the stomach empties slowly. But what if gastroparesis is not the cause? Understanding other factors behind these symptoms can help improve management and quality of life.

HEDS is a connective tissue disorder that affects joints, skin, and internal organs. The connective tissue weakness can impact the gastrointestinal (GI) tract, leading to various digestive symptoms. Common issues include:

• Acid reflux

• Nausea

• Bloating

• Irregular bowel movements

  
  

Many people with HEDS are diagnosed with gastroparesis because delayed stomach emptying explains some symptoms. However, not all digestive problems in HEDS come from gastroparesis. Other causes may be at play, especially when symptoms like chronic cough and alternating constipation and diarrhea persist.

Chronic cough in HEDS is often linked to reflux, but reflux itself can have multiple causes beyond gastroparesis:

• Laryngopharyngeal reflux (LPR): Unlike typical acid reflux, LPR affects the throat and voice box. It can cause a persistent cough without the classic heartburn symptoms.

• Esophageal dysmotility: Weak or uncoordinated muscle contractions in the esophagus can cause food and acid to move abnormally, triggering cough and throat irritation.

• Postnasal drip: HEDS can affect connective tissue in the sinuses, leading to increased mucus production and drainage down the throat, which irritates the airway.

  
  

If gastroparesis is ruled out, exploring these causes with a healthcare provider can lead to better treatment options.

Reflux symptoms in HEDS may not always stem from delayed stomach emptying. Other factors include:

• Hiatal hernia: A common condition in HEDS where part of the stomach pushes through the diaphragm, worsening reflux.

• Lower esophageal sphincter (LES) dysfunction: The LES is a muscle that prevents stomach acid from rising into the esophagus. Weakness or improper relaxation can cause reflux.

• Increased abdominal pressure: Due to connective tissue laxity, the abdominal organs may shift, increasing pressure and promoting reflux.

  
  

Addressing these issues might involve lifestyle changes, medications, or in some cases, surgical options.

Alternating bowel habits can be confusing and frustrating. In HEDS, these symptoms may result from:

• Autonomic nervous system dysfunction: This system controls involuntary bodily functions, including digestion. Dysregulation can cause irregular bowel movements.

• Small intestinal bacterial overgrowth (SIBO): Excess bacteria in the small intestine can cause bloating, diarrhea, and constipation.

• Irritable bowel syndrome (IBS): IBS is common in HEDS and causes alternating bowel habits, abdominal pain, and discomfort.

• Pelvic floor dysfunction: Weak or uncoordinated pelvic muscles can affect bowel movements, leading to constipation or incomplete evacuation.

  
  

Testing for these conditions can help tailor treatment plans beyond focusing solely on gastroparesis.

Managing chronic cough, reflux, and bowel irregularities in HEDS requires a comprehensive approach:

• Work with specialists: Gastroenterologists familiar with connective tissue disorders can provide targeted care.

• Keep a symptom diary: Track foods, activities, and symptoms to identify triggers.

• Diet adjustments: Low FODMAP diets or small, frequent meals may reduce symptoms.

• Medications: Proton pump inhibitors, prokinetics, or antibiotics for SIBO might be prescribed.

• Physical therapy: Pelvic floor therapy can improve bowel function.

• Lifestyle changes: Elevate the head during sleep, avoid tight clothing, and manage stress.

  
  

Each person’s experience is unique, so treatments should be personalized.

If symptoms persist despite treatment for gastroparesis, further evaluation is essential. Tests might include:

• Esophageal manometry to assess muscle function

• pH monitoring for acid exposure

• Breath tests for SIBO

• Pelvic floor assessments

  
  

Early diagnosis of other causes can prevent complications and improve daily comfort.