High Prescription Rates Show GI Symptoms Are Common, Especially in Teens

Prescription claims for medications for gastrointestinal (GI) symptoms — among them heartburn, indigestion, constipation, and diarrhea — are higher among children and adults with Ehlers-Danlos syndrome (EDS) than in people without these genetic connective tissue disorders, according to a medicinal claims analysis.

These findings clearly show that GI symptoms are common in people with EDS.

Moreover, women were found to have higher prescription rates than men, especially during adolescence — which suggests an essential window of time for new interventions, the researchers said. 

The analysis was published in the journal Neurogastroenterology & Motility, in a study titled “Gastrointestinal medication burden among persons with the Ehlers‐Danlos syndromes.” 

Beyond stretchy, fragile skin and overly flexible joints, studies have shown that people with EDS also experience problems involving the gastrointestinal (GI) tract. Among common GI symptoms in these patients are acid reflux, known as heartburn, chronic or recurring indigestion, constipation, abdominal pain, bloating, and diarrhea.

Despite these well-established symptoms, however, the use of medications to manage these GI problems by EDS patients is not well documented. There has been little research into prescription claims for medications for pain and constipation, or for acid suppressants, among this patient population, investigators say.

Now, a team based at the Penn State Health Milton S. Hershey Medical Center, in Pennsylvania, examined an extensive medical prescription claims database for medication use for GI symptoms among people with EDS.

Data were obtained from the MarketScan Commercial Claims and Encounters database, which includes employer-based patient data. Information on reimbursed claims for more than 240 million patients covered by more than 130 payers was provided from this database.

The investigators searched the database for all inpatient and outpatient claims between 2005 and 2014 for people diagnosed with EDS.

Other selection criteria included those between the ages of 5 and 62, who had continuous enrollment for two years after starting in a MarketScan-covered insurance plan, and prescription drug coverage in an individual’s insurance plan. As a comparison, a matched control group without EDS was analyzed.

Medications were assessed in groups that included: acid suppressants, vomiting and nausea medications (anti-emetics), and therapies for irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD). IBS is a term for symptoms due to slow or fast intestinal movement, while IBD includes conditions that cause GI swelling and irritation, such as Crohn’s disease and ulcerative colitis.

For those with persistent abdominal pain despite IBS therapy, visceral hypersensitivity (VHS) therapies were prescribed.

The EDS group consisted of 4,294 people, of whom 1,447 (33.7%) were children, and 2,847 (66.3%) were adults. The majority of participants were female.

The results showed that prescription claims for at least one GI medication group — and in each of the three medication groups — were higher among individuals with EDS compared with controls.

A total of 38.6% of EDS patients received at least one GI medication, compared with 16.4% of controls. For acid suppressants, these values were 23.4% for EDS versus 8.8% for controls, and for anti-emetics, they were 16.7% among those with EDS versus 4.9% in controls. The values for VHS medicines were 19.3% versus 3.4% in controls. For IBS therapies, 16.0% of EDS patients received at least one medication versus 6.8% of controls. For IBD medications, the values were 1.1% versus 0.3% in controls.

In terms of age, 25.7% of EDS children had at least one GI medicine prescription, compared with 7.4% of control participants. In adults, 45.1% of those with EDS had claims for at least one GI drug group compared with 21.0% of controls.

In terms of gender, 44.0% of EDS women (versus 19.2% of controls) and 25.3% of men with EDS (versus 9.6% of controls) had prescription claims for at least one class of GI drugs.

The highest proportion of GI prescription claims were for acid suppressants in all groups: children (15.3% vs. 3.0% in controls), adults (27.5% vs. 11.8% in controls), women (25.9% vs. 10.0% in controls), and men (17.3% vs. 6.0% in controls).

Over the 2-year observation period, in comparison with controls, individuals with EDS had higher prescription claims for the one-, two-, and three-GI-medication groups. Furthermore, there was a steady increase in most prescription claims across age among men and women with EDS than in sex-matched controls.

Acid suppressants were among the medicines that showed a rising trend across age for both sexes, particularly in those with EDS. Nausea and vomiting medications increased markedly among female adolescents with EDS, peaking around age 30 and remaining high into their 40s. No trends were found across age in the use of nausea/vomiting medications among males.

IBS medication claims rose slightly in both female adolescent cases and controls, likely from increased antispasmodic prescription claims for stomach cramps. No comparable increase was observed in male participants.

VHS therapies increased among people with EDS in both sexes, compared with controls, with adolescent EDS females showing the higher increase. Notably, such increases remained high through the third decade, followed by a second rise in the late fourth decade of life.

“In summary, our study highlights the important issue of high GI medication prescriptions underscoring that GI [problems are] common among people with EDS,” the researchers wrote.

“Women with EDS have higher prescriptions compared to men, especially increasing in the adolescent years, which suggests a critical time window on which to focus future research and possible interventions,” they concluded.