Gastrointestinal symptoms are a frequent and often severe component of the clinical picture in patients with hypermobile Ehlers-Danlos syndrome (hEDS)/hypermobility spectrum disorders (HSD), postural orthostatic tachycardia syndrome (POTS), and mast cell activation syndrome (MCAS). This review synthesizes recent findings and provides a practical, structured framework to evaluate gastrointestinal complaints and to guide appropriate use of nutrition support in this population, where clinical practice is variable and escalation to non-oral nutrition can occur prematurely.
Emerging data indicate a high burden of gastrointestinal disease across these overlapping disorders. Patients commonly present with symptoms consistent with functional or motility disorders that span the alimentary tract. The review highlights that the frequency and severity of gastrointestinal manifestations in hEDS/HSD, POTS, and MCAS contribute substantially to morbidity and often prompt consideration of nutrition support.
Recent findings emphasize an elevated prevalence of disorders of gut–brain interaction (DGBI) and related eating disturbances, including avoidant/restrictive food intake disorder (ARFID), among affected individuals. These conditions increase the risk of inadequate oral intake and malnutrition. The review underscores that nutritional compromise in this group is multifactorial, reflecting physiologic, autonomic, and behavioral contributors.
The authors recommend a coordinated, systematic evaluation before escalating to non-oral nutrition. They advise integration of validated assessment tools into clinical workflows to characterize symptom etiology, eating behavior, nutritional status, and the presence of concomitant functional or motility disorders. The review states that such a structured evaluation should precede decisions about enteral or parenteral nutrition to avoid premature initiation of advanced support.
A clear decision pathway is emphasized: conservative and behavioral strategies should be trialed and documented before advancing to non-oral nutrition. When oral strategies fail, enteral nutrition is the preferred next step. Parenteral nutrition is framed as a last-resort therapy reserved for patients with established intestinal failure. The review cautions that in clinical practice enteral and parenteral nutrition have sometimes been started without adequate conservative trials.
Enteral nutrition is recommended when optimized oral strategies cannot meet nutritional needs. The review positions enteral support as preferable to parenteral because it preserves gut integrity and is generally associated with fewer systemic complications when the gastrointestinal tract remains at least partially functional. Specific procedural or formula choices were not detailed in the abstract and therefore are not reported here.
Parenteral nutrition should be reserved for true intestinal failure where enteral feeding is not feasible or safe. The authors highlight concerns that parenteral nutrition is sometimes initiated prematurely in this population. They note that once advanced nutrition support is established, de-escalation can be challenging, reinforcing the need for careful initial decision-making and ongoing reassessment.
The review emphasizes the role of conservative measures and behavioral therapies in managing reduced oral intake and disordered eating patterns associated with these conditions. It notes that trials of such interventions are often inadequate or bypassed in practice, which may lead to unnecessary escalation to enteral or parenteral support. Details on specific behavioral modalities or durations were not provided in the abstract and are therefore not reported here.
To optimize outcomes and minimize harm, the authors recommend a multidisciplinary, biopsychosocial care model tailored to this complex population. Coordination among gastroenterology, nutrition, mental health, autonomic specialists, allergy/immunology (for MCAS), and other relevant disciplines is essential. The review contends that integrated care helps ensure appropriate evaluation, limits premature use of advanced nutrition therapies, and supports de-escalation when possible.
Key practice points distilled from the review include: perform a coordinated evaluation using validated tools before escalating to non-oral nutrition; prioritize conservative and behavioral approaches where appropriate; favor enteral nutrition over parenteral nutrition when oral strategies fail; reserve parenteral nutrition for true intestinal failure; and deliver care within a multidisciplinary, biopsychosocial model. The authors report that current variability in practice patterns and the tendency to initiate advanced nutrition support without adequate trials of less invasive interventions are important targets for improvement.
Information in this summary is derived from the abstract and metadata of the cited review (Curr Gastroenterol Rep. 2026;28(1):26; PMID 42611376). The abstract provides the overarching recommendations and themes; detailed protocols, specific assessment instruments, or granular outcome data referenced in the full article are not included in the abstract and therefore are not reported here.
The authors declared no competing interests in the article metadata.