Comorbid conditions do not differ in children and young adults with functional disorders with or without postural tachycardia syndrome
Open accessAbstract
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. Study design 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.
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Several recent studies have shown that comorbidities occur in increased frequency with each other regardless of whether a patient has POTS.
“Several recent studies have shown that these comorbidities occur in increased frequency with each other regardless of whether a patient has POTS, suggesting that POTS is simply another comorbid condition rather than the cause of these other conditions(69).”
From Postural Orthostatic Tachycardia Syndrome (2019) · cites this paper as [69]
The Results and Discussion (page unavailable) find similar comorbidity burdens with and without POTS and report associations among some conditions, particularly fibromyalgia and hypermobility. The paper says this pattern suggests POTS is another comorbid condition rather than the cause of the others. It does not show that all the comorbidities occur together at increased frequency; the Discussion calls the fibromyalgia–hypermobility link the only reliable association found in the study. (LLM, conf=0.84)
Experimental — accuracy not yet measuredPOTS is simply another comorbid condition rather than the cause of these other conditions.
“Several recent studies have shown that these comorbidities occur in increased frequency with each other regardless of whether a patient has POTS, suggesting that POTS is simply another comorbid condition rather than the cause of these other conditions(69).”
From Postural Orthostatic Tachycardia Syndrome (2019) · cites this paper as [69]
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Cites
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Sorted by citations
Postural Orthostatic Tachycardia Syndrome
Bryarly, M., Phillips, L. T., Fu, Q., Vernino, S., & Levine, B. D. (2019) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2018.11.059 · Cited by 245 · see citing works
Raj, S. R., Guzman, J. C., Harvey, P., Richer, L., Schondorf, R., Seifer, C., Thibodeau-Jarry, N., & Sheldon, R. S. (2020) · Canadian Journal of Cardiology · doi:10.1016/j.cjca.2019.12.024 · Cited by 223 · see citing works
Pediatric Disorders of Orthostatic Intolerance
Stewart, J. M., Boris, J. R., Chelimsky, G., Fischer, P. R., Fortunato, J. E., Grubb, B. P., Heyer, G. L., Jarjour, I. T., Medow, M. S., Numan, M. T., et al. (2018) · Pediatrics · doi:10.1542/peds.2017-1673 · Cited by 222 · see citing works
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Self-citation
- Authors
- Chelimsky, G., Kovacic, K., Nugent, M., Mueller, A., Simpson, P., & Chelimsky, T. C.
- Affiliations
- Medical College of Wisconsin (US)
- Venue
- The Journal of Pediatrics
- Publisher
- Elsevier BV
- Published
- 2015-07
- Volume
- 167
- Issue
- 1
- Pages
- 120-124
- ISSN
- 0022-3476 (ISSN-L)
- PMC
- PMC13180423
- OpenAlex
- W2008943602
- Cited by
- 52
- References
- 6
- Citations by year
- 2026: 5 · 2025: 3 · 2024: 2 · 2022: 7 · 2021: 4 · 2020: 9 · 2019: 6 · 2018: 4 · 2017: 3 · 2016: 7 · 2015: 2
- FWCI
- 4.98
- Type
- journal article
- Language
- en
- Open access
- Locations
- The Journal of Pediatrics (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (publishedVersion)
- Funders
- National Institute of Diabetes and Digestive and Kidney Diseases (R01DK083538)
- Topics
- Health Sciences › Medicine › Surgery › Cardiovascular Syncope and Autonomic Disorders
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Health Sciences › Medicine › Gastroenterology › Gastrointestinal motility and disorders
- Keywords
- postural orthostatic tachycardia syndrome, comorbidities, functional gastrointestinal disorders, chronic pain, fibromyalgia, joint hypermobility, autonomic dysfunction, dizziness, syncope, migraine, chronic fatigue, sleep disorders, children and young adults, tilt table test
- MeSH terms
- Adolescent, Adult, Child, Chronic Disease, Cross-Sectional Studies, Dizziness, Fatigue, Female, Fibromyalgia, Gastrointestinal Diseases, Humans, Joint Instability, Male, Migraine Disorders, Nausea, Retrospective Studies, Sleep Wake Disorders, Syncope, Postural Orthostatic Tachycardia Syndrome, Young Adult
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