Utility of Diagnostic Studies for Upper Gastrointestinal Symptoms in Children with Orthostatic Intolerance
Abstract
Objective To assess the utility of gastrointestinal (GI) diagnostic studies in the evaluation of patients with orthostatic intolerance.Study design Medical records of 103 consecutive children/young adults with orthostatic intolerance and gastrointestinal symptoms were reviewed. All patients had undergone antroduodenal manometry in conjunction with the tilt table test, autonomic testing, and upper gastrointestinal endoscopy (EGD). A gastric emptying study (GES) was performed in 81 patients.Results The median age of the cohort was 17 years (IQR, 15-19) with a female predominance (females:males, 3:1). As expected, the tilt table test was abnormal in all patients. Antroduodenal manometry was abnormal in 83 of 103 patients (81%), showing neurogenic intestinal dysmotility in 50%, rumination in 20%, and visceral hyperalgesia in 10%. The GES results were abnormal in 23 of 81 patients (28.4%), mostly (21 of 23) with delayed GES. None of the tilt table test or autonomic results were predictive of abnormal antroduodenal manometry or GES. Analysis of EGD biopsy samples revealed nonspecific esophagitis and/or gastritis in 16 of 103 patients (15%).Conclusions Antroduodenal manometry with the tilt table test were the most insightful investigations in adolescents and young adults with orthostatic intolerance and gastrointestinal symptoms. GES and EGD provided limited information. Gastrointestinal symptoms were related more to functional rather than mucosal or organic etiologies, suggesting a limited role of endoscopy alone in evaluating patients with orthostatic intolerance presenting with gastrointestinal symptoms.
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Gastrointestinal dysmotility is frequently diagnosed in POTS.
“Clinical diagnostic studies to identify gastrointestinal dysfunction are limited; however, gastrointestinal dysmotility is frequently diagnosed in POTS (DiBaise et al., 2018; Zhang et al., 2019).”
From Postural orthostatic tachycardia syndrome (POTS): State of the science and clinical care from a 2019 National Institutes of Health Expert Consensus Meeting - Part 1 (2021) · cites this paper as Zhang et al., 2019
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- Authors
- Zhang, L. N., Moak, J. P., Desbiens, J., Hanumanthaiah, S., Fabian, R. R., Clarke, L., Sahay, R. D., & Darbari, A.
- Affiliations
- Children's National (US)
- Cincinnati Children's Hospital Medical Center (US)
- Corresponding author
- Darbari, Anil
- Venue
- The Journal of Pediatrics
- Publisher
- Elsevier BV
- Published
- 2019-02
- Volume
- 205
- Pages
- 138-144
- ISSN
- 0022-3476 (ISSN-L)
- OpenAlex
- W2898170502
- Cited by
- 10
- References
- 22
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 2 · 2022: 2 · 2021: 2 · 2020: 1
- FWCI
- 0.71
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Journal of Pediatrics (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Gastroenterology › Gastrointestinal motility and disorders
- Health Sciences › Medicine › Surgery › Cardiovascular Syncope and Autonomic Disorders
- Health Sciences › Medicine › Gastroenterology › Gastroesophageal reflux and treatments
- Keywords
- orthostatic intolerance, gastrointestinal symptoms, antroduodenal manometry, tilt table test, gastric emptying study, upper gastrointestinal endoscopy, rumination, visceral hypersensitivity, delayed gastric emptying, esophagitis, gastritis, functional gastrointestinal disorders, adolescents and young adults
- MeSH terms
- Adolescent, Biopsy, Female, Gastrointestinal Diseases, Gastrointestinal Motility, Humans, Male, Manometry, Retrospective Studies, Endoscopy, Digestive System, Tilt-Table Test, Orthostatic Intolerance, Young Adult
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