Which digestive problems are described in POTS, hypermobility and hypermobile Ehlers-Danlos syndrome?
Telling apart digestive symptoms, disorders of gut-brain interaction (DGBI) and documented dysmotility in people with POTS or hEDS/HSD.
6sources
5min read
✓Clinical review
Verified9 November 2026
Key points
People living with hEDS/HSD or POTS frequently report digestive symptoms, but symptoms, disorders of gut-brain interaction (DGBI) and motility disorders demonstrated by testing are different categories [1, 2, 3].
A 2026 meta-analysis (19 studies, 17,455 people with hEDS/HSD) estimates that 65.3% report at least one chronic digestive symptom, with an odds ratio (a measure of the strength of an association) of 4.29 compared with controls; the authors rate the quality of the evidence as low because of clinical heterogeneity [2].
A POTS meta-analysis (19 studies, 8,268 patients) estimates that 57.9% have at least one gastrointestinal symptom; heterogeneity between studies is substantial [3].
The AGA states that testing for POTS or MCAS should be targeted to people with suggestive clinical features; systematic screening of everyone with hEDS/HSD is not supported by current data [1].
The Rome V criteria, published in 2026, replace Rome IV as the reference framework for DGBI; they reduce use of the term “functional” in favor of more precise terminology [4, 5].
New, worsening or worrying digestive symptoms call for a medical opinion, even in someone who already has POTS or hEDS: they should not be put down to these conditions by default.
Aziz Q, Harris LA, Goodman BP, Simrén M, Shin A. AGA Clinical Practice Update on GI Manifestations and Autonomic or Immune Dysfunction in Hypermobile Ehlers-Danlos Syndrome: Expert Review. Clinical Gastroenterology and Hepatology, 23(8):1291–1302 2025. DOI: 10.1016/j.cgh.2025.02.015. PMID: 40387691.(expert opinion)
Limitations: US expert review (best practice advice) without a systematic review or formal grading of the evidence. Read: abstract (16 best practice advice statements).
Declared conflicts of interest: Not reviewed in the part of the source that was read
Kulin D, Holtmann G, Fairlie T, Staller K, Nurko S, Keefer L, Drossman DA, Jones MP, Aziz Q, Shah A. Meta-Analysis: Chronic Gastrointestinal Symptoms and Comorbidities in Hypermobile Ehlers-Danlos Syndrome and Hypermobility Spectrum Disorders. Alimentary Pharmacology & Therapeutics, 64(5):574–589 2026. DOI: 10.1111/apt.70856. PMID: 42437376.(evidence synthesis)
Limitations: 19 studies; substantial clinical heterogeneity, quality of evidence rated low by the authors. Read: abstract and full text (PMC13466160).
Declared conflicts of interest: Several authors declare consulting activities or industry research funding (including Bayer, Ardelyx, AbbVie, Takeda); Q. Aziz sits on the medical advisory board of the Ehlers-Danlos Society
Kulin D, Shah A, Fairlie T, Staller K, Nurko S, Keefer L, Aziz Q, Drossman DA, Jones MP, Holtmann G. Gastrointestinal Symptoms and Systemic Comorbidities in Patients With POTS: A Systematic Review and Meta-Analysis. Neurogastroenterology & Motility, 38(4):e70305 2026. DOI: 10.1111/nmo.70305. PMID: 41952073.(evidence synthesis)
Limitations: 19 studies; substantial heterogeneity and wide confidence intervals. Read: abstract and full text (PMC13062037).
Declared conflicts of interest: Several authors declare consulting activities or industry research funding (including Bayer, Ardelyx, AbbVie, Takeda); Q. Aziz sits on the medical advisory board of the Ehlers-Danlos Society
Rome Foundation. Rome V: A Global Framework for Disorders of Gut–Brain Interaction. theromefoundation.org 2026.(guideline or consensus)
Limitations: Rome V overview page; the full volumes were not read.
Declared conflicts of interest: Institutional document; the Foundation sells the Rome V volumes
Krause A, Chang L. Rome V Criteria for Adults: What's New and Why?. United European Gastroenterology Journal, 14(8):e70307 2026. DOI: 10.1002/ueg2.70307. PMID: 42857891.(expert opinion)
Limitations: Explanatory review of the Rome V changes in adults; does not replace the criteria themselves. Read: abstract.
Declared conflicts of interest: Not reviewed in the part of the source that was read
Rome Foundation. What is a Disorder of Gut-Brain Interaction (DGBI)?. theromefoundation.org (publication date not stated; page postdates Rome V) 2026.(guideline or consensus)
Limitations: General information page on DGBI; mechanisms are presented as hypotheses (“thought to originate”).
Declared conflicts of interest: Institutional document
Written by
AI-assisted literature research (ChatGPT) and AI-assisted writing (Claude)
Editor
Jean Viry-Babel
Review status
Clinical review: Dr Françoise Charmoillaux (anesthesiologist)
Approved on
9 November 2026
Literature search
8 November 2026
Last verified
9 November 2026
Geographic scope
international, United States, France
Audience
everyone
Conflicts of interest
No known financial ties. Separately, the publisher is developing a personal approach to these conditions under the name Connected Conditions, which is not cited here (see the legal notice).
Limitations of this page
General overview: cannot be used to diagnose gastroparesis or a DGBI, or to choose a test or a diet. Prevalence figures are heterogeneous estimates; the AGA update was read from its abstract only. Page not reviewed by a gastroenterologist.