Disturbances of gastrointestinal transit and autonomic functions in postural orthostatic tachycardia syndrome

A. Loavenbruck, J. Iturrino, Wolfgang Singer, D. M. Sletten, Phillip Anson Low, A. R. Zinsmeister, Adil Eddie Bharucha

Research output: Contribution to journalArticle

28 Citations (Scopus)

Abstract

Background: Gastrointestinal symptoms are common in the postural orthostatic tachycardia syndrome (POTS). However, few studies have evaluated gastrointestinal transit in POTS. Our primary objectives were to evaluate gastrointestinal emptying and the relationship with autonomic dysfunctions in POTS. Methods: We reviewed the complete medical records of all patients aged 18 years and older with POTS diagnosed by a standardized autonomic reflex screen who also had a scintigraphic assessment of gastrointestinal transit at Mayo Clinic Rochester between 1998 and 2012. Associations between specific gastric emptying and autonomic (i.e., cardiovagal, adrenergic, and sudomotor) disturbances were evaluated. Key Results: Among 163 patients (140 women, mean [±SEM] age 30 [±1] years), 55 (34%) had normal, 30 (18%) had delayed, and 78 (48%) had rapid gastric emptying. Fifty-eight patients (36%) had clinical features of physical deconditioning, which was associated (p = 0.02) with rapid gastric emptying. Associations with delayed gastric emptying included vomiting, which was more common (p < 0.003), and anxiety or depression, which was less common (p = 0.02). The tilt-associated increase in heart rate and reduction in systolic BP at 1 min was associated (p < 0.05), being greater in patients with delayed gastric emptying. Conclusions & Inferences: Two-thirds of patients with POTS and GI symptoms had abnormal, most frequently rapid gastric emptying. Except for more severe adrenergic impairment in patients with delayed gastric emptying, the pattern of autonomic dysfunction did not discriminate among gastric emptying groups. Further studies are necessary to ascertain whether extravascular volume depletion and/or deconditioning contribute to POTS in patients with gastrointestinal symptoms.

Original languageEnglish (US)
Pages (from-to)92-98
Number of pages7
JournalNeurogastroenterology and Motility
Volume27
Issue number1
DOIs
StatePublished - Jan 1 2015

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Postural Orthostatic Tachycardia Syndrome
Gastrointestinal Transit
Gastric Emptying
Adrenergic Agents
Vomiting
Medical Records
Anxiety
Heart Rate
Depression

Keywords

  • Dumping
  • Gastric emptying
  • Gastroparesis
  • POTS

ASJC Scopus subject areas

  • Endocrine and Autonomic Systems
  • Gastroenterology
  • Physiology

Cite this

Disturbances of gastrointestinal transit and autonomic functions in postural orthostatic tachycardia syndrome. / Loavenbruck, A.; Iturrino, J.; Singer, Wolfgang; Sletten, D. M.; Low, Phillip Anson; Zinsmeister, A. R.; Bharucha, Adil Eddie.

In: Neurogastroenterology and Motility, Vol. 27, No. 1, 01.01.2015, p. 92-98.

Research output: Contribution to journalArticle

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abstract = "Background: Gastrointestinal symptoms are common in the postural orthostatic tachycardia syndrome (POTS). However, few studies have evaluated gastrointestinal transit in POTS. Our primary objectives were to evaluate gastrointestinal emptying and the relationship with autonomic dysfunctions in POTS. Methods: We reviewed the complete medical records of all patients aged 18 years and older with POTS diagnosed by a standardized autonomic reflex screen who also had a scintigraphic assessment of gastrointestinal transit at Mayo Clinic Rochester between 1998 and 2012. Associations between specific gastric emptying and autonomic (i.e., cardiovagal, adrenergic, and sudomotor) disturbances were evaluated. Key Results: Among 163 patients (140 women, mean [±SEM] age 30 [±1] years), 55 (34{\%}) had normal, 30 (18{\%}) had delayed, and 78 (48{\%}) had rapid gastric emptying. Fifty-eight patients (36{\%}) had clinical features of physical deconditioning, which was associated (p = 0.02) with rapid gastric emptying. Associations with delayed gastric emptying included vomiting, which was more common (p < 0.003), and anxiety or depression, which was less common (p = 0.02). The tilt-associated increase in heart rate and reduction in systolic BP at 1 min was associated (p < 0.05), being greater in patients with delayed gastric emptying. Conclusions & Inferences: Two-thirds of patients with POTS and GI symptoms had abnormal, most frequently rapid gastric emptying. Except for more severe adrenergic impairment in patients with delayed gastric emptying, the pattern of autonomic dysfunction did not discriminate among gastric emptying groups. Further studies are necessary to ascertain whether extravascular volume depletion and/or deconditioning contribute to POTS in patients with gastrointestinal symptoms.",
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