Comorbid Conditions Do Not Differ in Children and Young Adults with Functional Disorders with or without Postural Tachycardia Syndrome.
OBJECTIVE
To determine if several multisystem comorbid conditions occur more frequently in subjects with tilt-table defined postural tachycardia syndrome (POTS) compared with those without.


METHODS
Retrospective chart review of 67 subjects aged 6-24 years, referred to a tertiary care neurogastroenterology and autonomic disorders clinic for a constellation of functional gastrointestinal, chronic pain, and autonomic complaints. All patients underwent formal autonomic testing, Beighton scores assessment for joint hypermobility (0-9), and fibromyalgia tender points (0-18) (43 subjects).


RESULTS
Twenty-five subjects (37%) met tilt table criteria for POTS. The median age of 16 years (range, 12-24 years) in the POTS group differed from 15 years (range, 6-21 years) in the no-POTS group (P = .03). Comorbidities including chronic fatigue, sleep disturbances, dizziness, syncope, migraines, functional gastrointestinal disorders, chronic nausea, fibromyalgia, and joint hypermobility did not differ between groups. All subjects with fibromyalgia by tender point-examination had a Beighton score ≥ 4 (P = .002).


CONCLUSIONS
Comorbid conditions are equally prevalent in children and young adults with and without tilt-table defined POTS, suggesting that POTS itself is not a cause of the other comorbidities. Instead, POTS likely reflects another comorbid condition in children with functional disorders. Dizziness and syncope, classically associated with POTS, are not predictive of a diagnosis of POTS by tilt table, a test that is still required for formal diagnosis. These results suggest a paradigm shift in the concept of POTS as the physiological basis of many functional symptoms.
Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Center for Pediatric Neurogastroenterology, Motility, and Autonomic Disorders, Medical College of Wisconsin, Milwaukee, WI.
Gisela
G
Chelimsky
Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Center for Pediatric Neurogastroenterology, Motility, and Autonomic Disorders, Medical College of Wisconsin, Milwaukee, WI.
Katja
K
Kovacic
Division of Quantitative Health Sciences, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI.
Melodee
M
Nugent
Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Center for Pediatric Neurogastroenterology, Motility, and Autonomic Disorders, Medical College of Wisconsin, Milwaukee, WI.
Adriane
A
Mueller
Division of Quantitative Health Sciences, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI.
Pippa
P
Simpson
Department of Neurology, Medical College of Wisconsin, Milwaukee, WI.
Thomas C
TC
Chelimsky
D000293:Adolescent; D000328:Adult; D002648:Child; D002908:Chronic Disease; D003430:Cross-Sectional Studies; D004244:Dizziness / Q000150:complications; D005221:Fatigue / Q000150:complications; D005260:Female; D005356:Fibromyalgia / Q000150:complications; D005767:Gastrointestinal Diseases / Q000150:complications; D006801:Humans; D007593:Joint Instability / Q000150:complications; D008297:Male; D008881:Migraine Disorders / Q000150:complications; D009325:Nausea / Q000150:complications; D054972:Postural Orthostatic Tachycardia Syndrome / Q000150:complications*; D012189:Retrospective Studies; D012893:Sleep Wake Disorders / Q000150:complications; D013575:Syncope / Q000150:complications; D055815:Young Adult