Dysautonomia and joint hypermobility as a subtype of EoE

Eosinophilic oesophagitis (EoE) is a heterogenous disease, which means that it can present and respond to treatment differently between each patient. Many patients will also live with one or more comorbid conditions, which can include: 

  • Allergic diseases (e.g. atopic dermatitis, food allergy, and hayfever) 

  • Asthma 

  • Mental health conditions (e.g. anxiety and depression) 

  • Neurodevelopmental conditions (e.g. autism)

A new study provides more evidence for this link and identifies dysautonomia and joint hypermobility as a distinct subtype of EoE, supporting the idea of EoE as a heterogenous disease.

What is dysautonomia and joint hypermobility? 

Dysautonomia 

Dysautonomia, also known as autonomic dysfunction, is an umbrella term for a group of conditions that affect the way your autonomic nervous system works (ANS). The ANS controls the functions of your body that you don’t consciously think about, including: 

  • Heart rate 

  • Blood pressure 

  • Digestion 

  • Kidney function 

  • Controlling your body’s temperature 

There are lots of different forms of dysautonomia and symptoms can vary depending on what functions are affected. Some forms, such as postural tachycardia syndrome (POTS), are more common than others.

Joint hypermobility

Joint hypermobility, sometimes referred to as being double-jointed, is when some or all of your joints have a larger range of motion than normal, making them very flexible. Most people experience no problems due to their hypermobility, but in some people it can cause pain, dislocations, or fatigue, or increase the risk of injury.

Sometimes, hypermobility can be a sign of certain connective tissue disorders (CTDs) like hypermobile Ehler Danlos Syndrome (hEDS) or hypermobility spectrum disorder (HSD).

Dysautonomia and joint hypermobility as a subtype of EoE 

Researchers assessed the symptoms of 80 EoE patients to understand the relationship between autonomic symptoms, hypermobility, and EoE. 

They found that EoE patients experienced more autonomic symptoms (most commonly light-headedness upon standing) than people without EoE, and that these symptoms were increased in patients with active EoE compared to those in remission. Not only do these findings suggest a link between dysautonomia and EoE, but they also highlight the importance of achieving remission. 

Interestingly, the authors noted that light-headedness was more common in girls with EoE. This emphasises the heterogeneous nature of EoE, making it important to tailor care to individuals and the variation of symptoms and comorbid conditions they live with. 

They also found that 26% of participants with EoE were hypermobile. These patients tended to have increased autonomic symptoms, underlining the close link between dysautonomia and hypermobility. 

Together, these findings suggest the existence of a distinct subtype of EoE, making it important for healthcare professionals to look beyond classical EoE symptoms to gain a holistic understanding of their patient’s health.

Learn more about EoE and CTDs

Impact on quality of life 

The authors also assessed participants quality of life (QOL), and reported that autonomic symptoms were associated with a lower QOL. 

The good news is that there are already several interventions and treatments that can help manage dysautonomia and hypermobility. For example, chronic light-headedness can be treated by increasing salt and fluid intake and by engaging in exercise. Physical therapy can help reduce the risk of injuries and dislocations in hypermobile joints. Making these treatments accessible will help limit the impact of this EoE subtype on QOL. 

However, the authors stressed that despite the impact these symptoms may have on QOL, patients may not always think to mention them when discussing their EoE with their doctor. This can make it difficult to access the right care. But by remaining mindful of this EoE subtype and proactively asking about non-gastrointestinal symptoms, HCPs can build a clearer picture of their patients’ overall health and better direct them to the support they need.

Is this connection unique to EoE? 

It’s unclear. This study focused solely on EoE patients, and more research is needed to work out if this connection is limited to EoE or if it can occur alongside other eosinophilic diseases or inflammatory conditions.

Conclusion

The authors recognised dysautonomia and joint hypermobility as a distinct subtype of EoE, noting that: 

  • 26% of participants with EoE also had joint hypermobility.

  • Autonomic symptoms were increased in participants with active EoE and hypermobility. 

  • Light-headedness upon standing was more common in girls with EoE.

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Read the full study

Reference:

Patel, R.H. et al. (2026) 'Dysautonomia and joint hypermobility reflect a distinct subtype in eosinophilic esophagitis,' Journal of Allergy and Clinical Immunology https://doi.org/10.1016/j.jaci.2026.05.027

Related news:

https://www.eosnetwork.org/News/gi-symptoms-joint-hypermobility-study

https://www.eosnetwork.org/News/eosinophilic-diseases-research-past-present-future

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