Gastrointestinal manifestations of postural orthostatic tachycardia syndrome (P1.280)

Abstract

OBJECTIVE: Identify common gastrointestinal (GI) symptoms associated with postural orthostatic tachycardia syndrome (POTS). BACKGROUND: POTS is a type of dysautonomia associated with disturbances involving multiple organ systems, including chronic GI symptoms. Previous studies have identified common GI complaints in these patients and shown abnormal gastric electrical activity and gastric emptying. However, the full spectrum of GI symptoms and their impact on quality of life remains unclear. DESIGN/METHODS: Surveys were given to twenty-one patients with POTS seen in the Boston Medical Center autonomic clinic. This included a list of 30 questions describing various GI symptoms to which patients’ answers were recorded on a Likert rating scale. Symptoms were considered positive if patients answered “strongly agree” or “agree” and negative if they answered “strongly disagree” or “disagree.” RESULTS: The most commonly reported GI symptom was nausea (85.7[percnt]). Other common symptoms included heartburn (71.4[percnt]), irregular bowel movements (71.4[percnt]), abdominal pain (66.7[percnt]), constipation (66.7[percnt]), abdominal cramping (61.9[percnt]), and bloating (57.1[percnt]). Additionally, 81[percnt] of patients reported having GI symptoms more than once per week, and 71.4[percnt] of patients reported symptoms lasting for at least a few hours. The majority of patients (61.9[percnt]) reported having seen a GI specialist, however most patients denied having a diagnosis of inflammatory bowel disease (76.1[percnt]). Eight patients reported undergoing a gastric emptying study, which was positive for gastroparesis in four patients. CONCLUSIONS: Subjective GI disturbance is common in patients with POTS, and these symptoms are not necessarily related to primary GI pathology. Symptoms are frequent and prolonged, likely decreasing quality of life. Given the importance of autonomic input to normal GI function, the same autonomic impairment that leads to postural tachycardia may also affect the enteric nervous system, leading to gastroparesis, abnormal gut motility, and esophageal reflux. Further studies correlating subjective symptoms with objective abnormalities of GI autonomics are needed.

Disclosure: Dr. Morgenshtern has nothing to disclose. Dr. Culbertson has nothing to disclose. Dr. Wang has nothing to disclose. Dr. Deb has nothing to disclose. Dr. Hohler has nothing to disclose.