Gastrointestinal symptoms in postural tachycardia syndrome: a systematic review

Abstract

Gastrointestinal symptoms are among the most common complaints in patients with postural tachycardia syndrome (POTS). In some cases, they dominate the clinical presentation and cause substantial disabilities, including significant weight loss and malnutrition, that require the use of invasive treatment to support caloric intake. Multiple cross-sectional studies have reported a high prevalence of gastrointestinal symptoms in POTS patients with connective tissue diseases, such as Ehlers-Danlos, hypermobile type, and in patients with evidence of autonomic neuropathy. Previous studies that evaluated gastric motility in these patients reported a wide range of abnormalities, particularly delayed gastric emptying. The pathophysiology of gastrointestinal symptoms in POTS is likely multifactorial and probably depends on the co-morbid conditions. In patients with POTS and Ehlers-Danlos syndromes, structural and functional abnormalities in the gastrointestinal connective tissue may play a significant role, whereas in neuropathic POTS, the gastrointestinal tract motility and gut hormonal secretion may be directly impaired due to localized autonomic denervation. In patients with normal gastrointestinal motility but persistent gastrointestinal symptoms, gastrointestinal functional disorders should be considered. We performed a systematic review of the literature related to POTS and gastrointestinal symptoms have proposed possible mechanisms and discussed diagnosis and treatment approaches for delayed gastric emptying, the most common gastrointestinal abnormality reported in patients with POTS.

Functional gastrointestinal disorders are increased in joint hypermobility‐related disorders with concomitant postural orthostatic tachycardia syndrome

“…6,7 Moreover, a wide array of upper and lower gastrointestinal symptoms-such as dysphagia, reflux, nausea, abdominal pain, bloating, and altered bowel habit-are reported by up to 80% of subjects with POTS. 8,9 The etiology of gastrointestinal symptoms in POTS is not entirely clear. 9,10 The role of abnormal splanchnic blood flow has been questioned due to limited and conflicting results.…”

Gastric Myoelectrical Activity and Autonomic Nervous System Abnormalities in Patients with Chronic Unexplained Nausea and Vomiting and in Patients with Gastroparesis

“…Our patients were seen in GI clinic that specializes in the diagnosis and treatment of patients with chronic nausea and vomiting. ANS dysfunction is associated with a variety of gastric neuromuscular abnormalities including GP, rapid emptying, and gastric dysrhythmias [14][15][16]39,40]. In a study of 22 patients with POTS and GI symptoms identified from retrospective review of medical records at Mayo Clinic, 9% had delayed and 27% had rapid gastric emptying [14].…”

Factors Associated With Use of Nonoral Nutrition and Hydration Support in Adult Patients With Postural Tachycardia Syndrome

“…Whether this reflects a more severe form of autonomic neuropathy whereby the enteric nervous system is the primary site of impairment requires additional study. Importantly, although POTS is generally not considered to be a form of autonomic failure, (12) and dyssynergia (10). e Esophageal manometry abnormalities include ineffective/absent peristalsis (7), lower esophageal sphincter hypotension (5), and nutcracker esophagus (1).…”

“…Gastrointestinal (GI) symptoms occur commonly in patients with POTS and are a source of considerable frustration, disability, and impairment in quality of life . The cause of these GI symptoms, in many instances, remains unclear.…”