Distinct Age Patterns and Elevated Healthcare Utilization in Irritable Bowel Syndrome Patients with Ehlers-Danlos Syndrome: A National Inpatient Database Analysis

Ehlers-Danlos syndromes (EDS) are hereditary connective tissue disorders increasingly linked to gastrointestinal conditions, including irritable bowel syndrome (IBS). However, large-scale epidemiologic evidence describing this association, its subtype patterns, and related healthcare burden remains limited. To examine the association between EDS and IBS among hospitalized patients, including variation across IBS subtypes and differences in healthcare utilization. We conducted a retrospective cross-sectional analysis of the 2017–2019 National Inpatient Sample, representing over 106 million weighted U.S. hospitalizations. EDS and IBS were identified using ICD-10-CM codes, excluding Marfan syndrome and hypermobility spectrum disorders. Survey-weighted logistic and linear regression models assessed associations between EDS and IBS, IBS subtypes, age distribution, length of stay (LOS), hospitalization costs, and in-hospital mortality, with sequential adjustment for demographic, socioeconomic, hospital-level, and clinical confounders. Among 953,430 weighted IBS hospitalizations, 2475 (0.26%) had concurrent EDS; 6.23% of EDS hospitalizations had IBS. EDS was strongly associated with IBS in unadjusted analysis (OR 7.44, 95% CI 6.76–8.18) and after full adjustment (aOR 4.16, 95% CI 3.75–4.61). Patients with both conditions were hospitalized nearly 24 years younger than those with IBS alone. EDS was associated with longer LOS (adjusted + 0.75 days; 14.3% increase) and higher geometric mean hospitalization costs (12.4% increase). Associations were strongest for mixed-type IBS (aOR 7.10) and constipation-predominant IBS (aOR 5.85). EDS is strongly associated with IBS among inpatients, characterized by earlier presentation and increased inpatient healthcare utilization, highlighting the need for improved recognition and integrated care.