Could Your Gut Pain Be EDS-Related? with Dr. Pradeep Chopra (Ep 157)

Pain specialist Dr. Pradeep Chopra discusses why gastrointestinal pain is common in hypermobile Ehlers-Danlos syndrome and often overlaps with POTS and MCAS. He outlines mechanisms such as connective‑tissue laxity (leading to reflux/hiatal hernia and pelvic organ issues), disordered motility (constipation, gastroparesis, bloating, SIBO/SIFO), autonomic dysfunction driving nausea/early satiety, and mast‑cell–mediated inflammation and visceral hypersensitivity. He reviews a practical workup that prioritizes ruling out red flags (alarm symptoms, weight loss, bleeding), screening for common mimics (celiac disease, IBD, gallbladder issues, endometriosis), and selectively using tests like gastric emptying studies, transit testing, manometry, and breath testing—while being cautious about over‑testing and unnecessary surgery. Management emphasizes foundations first: fluids/salt (for POTS), regular meals, fiber titration, magnesium/osmotic laxatives, gentle physical activity and pelvic‑floor PT, and nutrition trials (low‑FODMAP under guidance, and sometimes low‑histamine). He discusses targeted medications when indicated: acid suppression for GERD, prokinetics (e.g., prucalopride/other options) for dysmotility, H1/H2 blockers and cromolyn for suspected MCAS, and neuromodulators (low‑dose TCAs/SNRIs, gabapentinoids) for visceral hypersensitivity—while avoiding chronic opioids. He notes consideration of vascular compression syndromes (e.g., MALS/SMAS) only with consistent symptoms and objective findings. The take‑home is a multidisciplinary, stepwise approach that treats dysmotility, autonomic and mast‑cell contributors, optimizes pain modulation, and reserves procedures for clear indications.