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In this issue Lam and colleagues review the assessment and management of gastrointestinal symptoms and nutritional issues in patients with hypermobility disorders. Presentation to secondary and tertiary care centres is increasing. There is a lack of specific guidance and management can be challenging including the potential for iatrogenic harm. Key points include – the true prevalence of hypermobility disorders is unknown; gut symptomatology is often due to disorders of gut brain interaction and in the absence of objective evidence of dysmotility or other dysfunction, a biopsychosocial model of treating symptoms can be the most effective; postural tachycardia syndrome has been demonstrated in around 30%; over 70% of patients have psychological symptoms (primary or secondary); patients often have a high medication burden; eating related symptoms are common leading to reduced oral intake and/or food avoidance; oral diet and oral nutrition supplements should be optimised first; the evidence for clinically assisted nutrition and hydration is for objectively demonstrated malnutrition or electrolyte disturbance only. The authors describe evidence-based strategies for management, with an emphasis on reducing the risk of iatrogenic harm and improving multidisciplinary team care. The article is helpful, practical and pragmatic - Editor’s Choice this month (See page 68) .