title: Gastrointestinal symptoms associated with orthostatic intolerance.
abstract: BACKGROUND
  The term orthostatic intolerance is used to describe symptoms of hemodynamic instability such as lightheadedness, fatigue, impaired cognition and syncope that develop on assuming an upright posture. Common forms of orthostatic intolerance in childhood include postural tachycardia syndrome and neurally mediated hypotension.
  
  
  OBJECTIVE
  A descriptive report of the clinical characteristics of patients presenting with gastrointestinal symptoms who are ultimately found to have orthostatic intolerance.
  
  
  METHODS
  A medical record review of all patients referred to the pediatric gastroenterology service at the Johns Hopkins Children's Center who had an abnormal tilt table test between June 1996 and December 2000.
  
  
  RESULTS
  Of 24 eligible subjects aged 9-17 years (mean, 14.3 years), four had postural tachycardia syndrome, eight had both postural tachycardia and neurally mediated hypotension, and 12 had neurally mediated hypotension alone. The most common presenting gastrointestinal symptoms were abdominal pain, nausea and vomiting. Median number of gastrointestinal symptoms per patient was 3 (range, 1-7), and 87% of the patients experienced gastrointestinal symptoms for more than 1 year and 48% experienced gastrointestinal symptoms for more than 3 years. Follow-up information was available on 18 patients. Seventy-eight percent of patients (14 of 18) had complete resolution of symptoms with treatment of orthostatic intolerance.
  
  
  CONCLUSIONS
  Pediatric patients with chronic upper gastrointestinal symptoms may have underlying orthostatic intolerance. In patients with upper gastrointestinal symptoms and orthostatic intolerance, treatment of orthostatic intolerance may result in resolution of gastrointestinal symptoms.
authors.affiliation: Department of Pediatric Gastroenterology, The Johns Hopkins University School of Medicine, The Johns Hopkins University, Baltimore, Maryland, USA.
authors.forename: Sean D
authors.initials: SD
authors.lastname: Sullivan
authors.forename: Joseph
authors.initials: J
authors.lastname: Hanauer
authors.forename: Peter C
authors.initials: PC
authors.lastname: Rowe
authors.forename: Diana F
authors.initials: DF
authors.lastname: Barron
authors.forename: Anil
authors.initials: A
authors.lastname: Darbari
authors.forename: Maria
authors.initials: M
authors.lastname: Oliva-Hemker
mesh_terms: D015746:Abdominal Pain / Q000175:diagnosis / Q000209:etiology*; D000293:Adolescent; D001794:Blood Pressure; D002648:Child; D015331:Cohort Studies; D003937:Diagnosis, Differential; D005260:Female; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D007024:Hypotension, Orthostatic / Q000150:complications* / Q000628:therapy; D008297:Male; D009325:Nausea / Q000209:etiology; D011187:Posture; D012189:Retrospective Studies; D013577:Syndrome; D013610:Tachycardia / Q000175:diagnosis / Q000209:etiology; D018667:Tilt-Table Test; D014839:Vomiting / Q000209:etiology