title: Gastrointestinal dysfunction in postural tachycardia syndrome.
abstract: BACKGROUND
  Postural tachycardia syndrome (POTS) is a dysautonomia defined by an exaggerated increase in heart rate upon changing posture. It is associated with disturbances involving multiple organ systems, including neurologic, dermatologic, and gastrointestinal (GI) symptoms. Previous studies identified GI complaints in these patients and showed gastric emptying and electrical activity abnormalities. However, the full spectrum of GI symptoms and their impact on quality of life remains unclear.
  
  
  METHODS
  A 30-question survey of GI symptoms was collected from 28 patients with POTS seen in the Boston Medical Center Autonomic Clinic. Answers were recorded on a Likert rating scale. Symptoms were positive if patients answered "strongly agree" or "agree" and negative if they answered "strongly disagree" or "disagree." Responses were collected and analyzed.
  
  
  RESULTS
  The most commonly reported GI symptoms were nausea (86%), irregular bowel movements (71%), abdominal pain (70%), and constipation (70%). Additionally, 82% of patients reported having GI symptoms more than once per week, and 71% reported having seen a GI specialist, and symptoms did not improve with changes in position. Twelve patients had undergone a gastric emptying study, and six of these patients reported receiving a diagnosis of gastroparesis or delayed gastric emptying.
  
  
  CONCLUSIONS
  GI disturbances are common, frequent, and prolonged in patients with POTS, likely impacting quality of life. Given the importance of the enteric nervous system to normal GI functioning, the same autonomic impairment leading to POTS may result in abnormal gut motility and ultimately subjective GI discomfort.
authors.affiliation: Boston University School of Medicine, Department of Neurology, 72 E. Concord Street, Boston, MA 02118, United States. Electronic address: lizbwang@bu.edu.
authors.forename: Liz B
authors.initials: LB
authors.lastname: Wang
authors.affiliation: Boston University School of Medicine, Department of Neurology, 72 E. Concord Street, Boston, MA 02118, United States. Electronic address: collinculbertson@gmail.com.
authors.forename: Collin J
authors.initials: CJ
authors.lastname: Culbertson
authors.affiliation: Boston University School of Medicine, Department of Neurology, 72 E. Concord Street, Boston, MA 02118, United States. Electronic address: anindita.deb@umassmemorial.org.
authors.forename: Anindita
authors.initials: A
authors.lastname: Deb
authors.affiliation: Boston University School of Medicine, Department of Neurology, 72 E. Concord Street, Boston, MA 02118, United States. Electronic address: karenvm23@gmail.com.
authors.forename: Karen
authors.initials: K
authors.lastname: Morgenshtern
authors.affiliation: Boston University School of Medicine, Department of Neurology, 72 E. Concord Street, Boston, MA 02118, United States. Electronic address: hhuang@bu.edu.
authors.forename: Hao
authors.initials: H
authors.lastname: Huang
authors.affiliation: Boston University School of Medicine, Department of Neurology, 72 E. Concord Street, Boston, MA 02118, United States. Electronic address: anna.hohler@bmc.org.
authors.forename: Anna DePold
authors.initials: AD
authors.lastname: Hohler
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D005767:Gastrointestinal Diseases / Q000150:complications*; D006801:Humans; D008297:Male; D054972:Postural Orthostatic Tachycardia Syndrome / Q000150:complications*; D012720:Severity of Illness Index; D055815:Young Adult
keywords: Constipation; Dysautonomia; Dysmotility; Gastric emptying; Gastrointestinal symptoms; Gastroparesis; POTS; Postural tachycardia