Orthostatic Intolerance and Gastrointestinal Motility in Adolescents With Nausea and Abdominal Pain
Abstract
Objective: To describe the relationships between gastric emptying, autonomic function, and postural tachycardia in adolescent patients with nausea and/or abdominal discomfort. It was hypothesized that patients with both gastrointestinal symptoms and symptoms of orthostatic intolerance are more likely to show abnormal tilt table results and delayed gastric emptying. Patients and Methods: A retrospective review was conducted of adolescent patients who came to a pediatric referral center because of nausea and dyspepsia and who subsequently underwent both autonomic reflex screening and gastric emptying testing. Patients with a heart rate change of 30 or more beats per minute on the heads‐up tilt table test were assigned to the postural orthostatic tachycardia syndrome (POTS) group (n = 21), and those with a heart rate change of fewer than 30 beats per minute on the heads‐up tilt table test were assigned to the non‐POTS group (n = 10). Results: There was no significant difference between the POTS and non‐POTS groups with regard to presenting symptoms (P > 0.05). Overall, 13 (42%) individuals had abnormal gastric emptying results (delayed in 6, accelerated in 7), but gastric emptying scores were similar between the POTS and non‐POTS groups. Furthermore, there was no correlation between an individual's gastric emptying results at 1, 2, and 4 hours and that person's heart rate change on HUT (r = −0.05, −0.15, and −0.19). Conclusions: Although altered gastric emptying and postural tachycardia are common in a referral population of adolescents with nausea and/or abdominal discomfort, the clinical presentation was not predictive of test results. Furthermore, delayed gastric emptying was not correlated with the current definition of postural tachycardia.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Four studies of GI symptoms in POTS reported abnormal gastric motility, with rapid gastric emptying in 43% and delayed gastric emptying/gastroparesis in 20%.
“Four of these studies that describe the GI symptoms in POTS also reported evidence of abnormal gastric motility- either rapid gastric emptying (43%) or delayed gastric emptying (gastroparesis, 20%) [5, 36, 48, 67].”
From Gastrointestinal symptoms in postural tachycardia syndrome: a systematic review (2018) · cites this paper as [5]
Cites
Idiopathic postural orthostatic tachycardia syndrome: An attenuated form of acute pandysautonomia?
Schondorf, R., & Low, P. A. (1993) · Neurology · doi:10.1212/wnl.43.1_part_1.132 · Cited by 548 · see citing works
The neuropathic postural tachycardia syndrome
Jacob, G., Costa, F., Shannon, J. R., Robertson, R. M., Wathen, M., Stein, M., Biaggioni, I., Ertl, A., Black, B., & Robertson, D. (2000) · New England Journal of Medicine · doi:10.1056/nejm200010053431404 · Cited by 398 · see citing works
The epidemic of orthostatic tachycardia and orthostatic intolerance
Robertson, D. (1999) · The American Journal of the Medical Sciences · doi:10.1016/s0002-9629(15)40480-x · Cited by 293 · see citing works
Testing the Autonomic Nervous System
Low, P. A. (2003) · Seminars in Neurology · doi:10.1055/s-2004-817725 · Cited by 241 · see citing works
Postural Tachycardia Syndrome: Clinical Features and Follow-up Study
Sandroni, P., Opfer-Gehrking, T. L., McPhee, B. R., & Low, P. A. (1999) · Mayo Clinic Proceedings · doi:10.4065/74.11.1106 · Cited by 194 · see citing works
Headache, Stomachache, Backache, and Morning Fatigue Among Adolescent Girls in the United States
Ghandour, R. M., Overpeck, M. D., Huang, Z. J., Kogan, M. D., & Scheidt, P. C. (2004) · Archives of Pediatrics and Adolescent Medicine · doi:10.1001/archpedi.158.8.797 · Cited by 182 · see citing works
Autonomic dysfunction in gastrointestinal motility disorders
Bharucha, A. E., Camilleri, M., Low, P. A., & Zinsmeister, A. R. (1993) · Gut · doi:10.1136/gut.34.3.397 · Cited by 141 · see citing works
Chronic orthostatic intolerance and the postural tachycardia syndrome (POTS)
Stewart, J. M. (2004) · The Journal of Pediatrics · doi:10.1016/j.jpeds.2004.06.084 · Cited by 116 · see citing works
The Postural Orthostatic Tachycardia Syndrome:
Kanjwal, Y., KOSINSKI, D. J., & Grubb, B. P. (2003) · Pacing and Clinical Electrophysiology · doi:10.1046/j.1460-9592.2003.t01-1-00262.x · Cited by 103 · see citing works
BRADY, P. A., LOW, P. A., & SHEN, W. K. (2005) · Pacing and Clinical Electrophysiology · doi:10.1111/j.1540-8159.2005.00227.x · Cited by 98 · see citing works
Persistent splanchnic hyperemia during upright tilt in postural tachycardia syndrome
Stewart, J. M., Medow, M. S., Glover, J. L., & Montgomery, L. D. (2006) · American Journal of Physiology-Heart and Circulatory Physiology · doi:10.1152/ajpheart.00784.2005 · Cited by 95 · see citing works
Gastric sensory and motor dysfunction in adolescents with functional dyspepsia
Chitkara, D. K., Camilleri, M., Zinsmeister, A. R., Burton, D. D., El‐Youssef, M., Freese, D. K., Walker, L. S., & Stephens, D. A. (2005) · The Journal of Pediatrics · doi:10.1016/j.jpeds.2004.11.031 · Cited by 89 · see citing works
Autonomic Abnormalities in Children With Functional Abdominal Pain: Coincidence or Etiology?
Chelimsky, G. G., Boyle, J. T., Tusing, L., & Chelimsky, T. C. (2001) · Journal of Pediatric Gastroenterology and Nutrition · doi:10.1097/00005176-200107000-00008 · Cited by 79 · see citing works
Lewis, D. A., Zlotocha, J., Henke, L., & Dhala, A. A. (1997) · Journal of the American College of Cardiology · doi:10.1016/s0735-1097(97)00255-6 · Cited by 72 · see citing works
The Postural Tachycardia Syndrome (PoTS)
Mathias, C. J., Owens, A. P., & Iodice, V. (2021) · Springer eBooks · doi:10.1007/978-3-030-62263-3_20 · Cited by 70 · see citing works
Gastrointestinal Symptoms Associated with Orthostatic Intolerance
Sullivan, S. D., Hanauer, J., Rowe, P. C., Barron, D. F., Darbari, A., & Oliva‐Hemker, M. (2005) · Journal of Pediatric Gastroenterology and Nutrition · doi:10.1097/01.mpg.0000157914.40088.31 · Cited by 68 · see citing works
VanDenbossche, J., Seelye, J. G., & Zielinski, B. S. (2008) · Brain Behavior and Evolution · doi:10.1159/000113382 · Cited by 66 · see citing works
The value of autonomic testing in postural tachycardia syndrome
Al-Shekhlee, A., Lindenberg, J. R., Hachwi, R. N., & Chelimsky, T. C. (2005) · Clinical Autonomic Research · doi:10.1007/s10286-005-0282-7 · Cited by 41 · see citing works
Evaluation and Treatment of Autonomic Disorders of the Gastrointestinal Tract
Chelimsky, G. G., & Chelimsky, T. C. (2003) · Seminars in Neurology · doi:10.1055/s-2004-817729 · Cited by 30 · see citing works
Familial association of autonomic and gastrointestinal symptoms
Chelimsky, G. G., & Chelimsky, T. C. (2001) · Clinical Autonomic Research · doi:10.1007/bf02292771 · Cited by 21 · see citing works
Abdominal Pain as the Presenting Symptom of Autonomic Dysfunction in a Child
Chelimsky, G. G., Hupertz, V. F., & Chelimsky, T. C. (1999) · Clinical Pediatrics · doi:10.1177/000992289903801205 · Cited by 19 · see citing works
Orthostatic intolerance and the biopsychosocial model
Hyman, P. E., & Danda, C. E. (2005) · Journal of Pediatric Gastroenterology and Nutrition · doi:10.1097/00005176-200504000-00004 · Cited by 4 · see citing works
Flagged first, then by citations
1 of the 23 references couldn’t be matched to a known paper.
Cited by
Sorted by citations
Postural tachycardia in children and adolescents: what is abnormal?
Singer, W., Sletten, D. M., Opfer-Gehrking, T. L., Brands, C. K., Fischer, P. R., & Low, P. A. (2012) · The Journal of Pediatrics · doi:10.1016/j.jpeds.2011.08.054 · Cited by 209 · see citing works
Self-citationPostural Orthostatic Tachycardia Syndrome: A Clinical Review
Johnson, J. N., Mack, K. J., Kuntz, N. L., Brands, C. K., Porter, C. J., & Fischer, P. R. (2010) · Pediatric Neurology · doi:10.1016/j.pediatrneurol.2009.07.002 · Cited by 119 · see citing works
Self-citationAdolescent Fatigue, POTS, and Recovery: A Guide for Clinicians
Kizilbash, S. J., Ahrens, S. P., Bruce, B. K., Chelimsky, G., Driscoll, S. W., Harbeck-Weber, C., Lloyd, R. M., Mack, K. J., Nelson, D. E., Ninis, N., et al. (2014) · Current Problems in Pediatric and Adolescent Health Care · doi:10.1016/j.cppeds.2013.12.014 · Cited by 120 · see citing works
Self-citationLoavenbruck, A., Iturrino, J., Singer, W., Sletten, D. M., Low, P. A., Zinsmeister, A. R., & Bharucha, A. E. (2015) · Neurogastroenterology & Motility · doi:10.1111/nmo.12480 · Cited by 63 · see citing works
Postural Tachycardia Syndrome (POTS) and the GI Tract: A Primer for the Gastroenterologist
DiBaise, J. K., Harris, L. A., & Goodman, B. (2018) · American Journal of Gastroenterology · doi:10.1038/s41395-018-0215-4 · Cited by 57 · see citing works
Kovacic, K. K., Elfar, W., Rosen, J. M., Yacob, D., Raynor, J., Mostamand, S., Punati, J. B., Fortunato, J. E., & Saps, M. (2019) · Neurogastroenterology & Motility · doi:10.1111/nmo.13780 · Cited by 57 · see citing works
Gastrointestinal symptoms in postural tachycardia syndrome: a systematic review
Mehr, S. E., Barbul, A., & Shibao, C. A. (2018) · Clinical Autonomic Research · doi:10.1007/s10286-018-0519-x · Cited by 55 · see citing works
Gastric emptying in postural tachycardia syndrome: a preliminary report
Park, K.-J., Singer, W., Sletten, D. M., Low, P. A., & Bharucha, A. E. (2013) · Clinical Autonomic Research · doi:10.1007/s10286-013-0193-y · Cited by 48 · see citing works
Zhao, J., Han, Z., Zhang, X., Du, S., Liu, A. D., Holmberg, L., Li, X., Lin, J., Xiong, Z., Gai, Y., et al. (2015) · BMJ Open · doi:10.1136/bmjopen-2014-007356 · Cited by 48 · see citing works
Tarbell, S. E., Shaltout, H. A., Wagoner, A. L., Diz, D. I., & Fortunato, J. E. (2014) · Experimental Brain Research · doi:10.1007/s00221-014-3981-2 · Cited by 42 · see citing works
Nausea in Children With Functional Abdominal Pain Predicts Poor Health Outcomes in Young Adulthood
Russell, A. C., Stone, A. L., & Walker, L. S. (2016) · Clinical Gastroenterology and Hepatology · doi:10.1016/j.cgh.2016.07.006 · Cited by 39 · see citing works
Gastric motor and sensory function
Tack, J. F. (2009) · Current Opinion in Gastroenterology · doi:10.1097/mog.0b013e328331b5ad · Cited by 36 · see citing works
Moak, J. P., Leong, D., Fabian, R., Freedenberg, V., Jarosz, E., Toney, C., Hanumanthaiah, S., & Darbari, A. (2016) · Pediatric Cardiology · doi:10.1007/s00246-015-1274-6 · Cited by 34 · see citing works
Abnormal gastric myoelectrical activity in postural tachycardia syndrome
Seligman, W. H., Low, D. A., Asahina, M., & Mathias, C. J. (2013) · Clinical Autonomic Research · doi:10.1007/s10286-012-0185-3 · Cited by 33 · see citing works
Functional Disability in Adolescents With Orthostatic Intolerance and Chronic Pain
Kritzberger, C. J., Antiel, R. M., Wallace, D. P., Zacharias, J. D., Brands, C. K., Fischer, P. R., & Harbeck‐Weber, C. (2011) · Journal of Child Neurology · doi:10.1177/0883073810390366 · Cited by 26 · see citing works
Self-citationMoak, J. P., Fabian, R. R., Clarke, L. C., Hanumanthaiah, S., Desbiens, J., & Darbari, A. (2016) · Journal of Pediatric Gastroenterology and Nutrition · doi:10.1097/mpg.0000000000001150 · Cited by 24 · see citing works
The utility of Valsalva maneuver in the diagnoses of orthostatic disorders
Palamarchuk, I. S., Baker, J. R., & Kimpinski, K. (2015) · American Journal of Physiology-Regulatory, Integrative and Comparative Physiology · doi:10.1152/ajpregu.00290.2015 · Cited by 24 · see citing works
Browne, P. D., de Bruijn, C. M. A., Speksnijder, E. M., den Hollander, B., van Wering, H. M., Wessels, M. M. S., Groeneweg, M., Goede, J., Frankenhuis, C., Tromp, E., et al. (2021) · Clinical Gastroenterology and Hepatology · doi:10.1016/j.cgh.2021.10.029 · Cited by 22 · see citing works
Functional Nausea in Children: A Review of the Literature and Need for Diagnostic Criteria
Russell, A. C., Stone, A. L., & Walker, L. S. (2016) · Children · doi:10.3390/children3010005 · Cited by 22 · see citing works
Upper Gastrointestinal Functional and Motility Disorders in Children
Miller, J. M., Khlevner, J., & Rodriguez, L. (2021) · Pediatric Clinics of North America · doi:10.1016/j.pcl.2021.07.009 · Cited by 23 · see citing works
Methodologic considerations for studies of chronic nausea and vomiting in adults and children
Hasler, W. L., Li, B. U. K., Koch, K. L., Parkman, H. P., Kovacic, K. K., & McCallum, R. W. (2016) · Autonomic Neuroscience · doi:10.1016/j.autneu.2016.08.001 · Cited by 19 · see citing works
Autonomic Nervous System Testing
Chelimsky, G. G., & Chelimsky, T. C. (2012) · Humana Press eBooks · doi:10.1007/978-1-60761-709-9_16 · Cited by 17 · see citing works
Approach to the Patient with Nausea and Vomiting
Hasler, W. L. (2015) · Wiley eBooks · doi:10.1002/9781118512074.ch38 · Cited by 16 · see citing works
Chelimsky, G. G., & Chelimsky, T. C. (2018) · Autonomic Neuroscience · doi:10.1016/j.autneu.2018.09.003 · Cited by 14 · see citing works
Ives, C. T., & Kimpinski, K. (2013) · Journal of Applied Physiology · doi:10.1152/japplphysiol.00292.2013 · Cited by 14 · see citing works
Zhang, L. N., Moak, J. P., Desbiens, J., Hanumanthaiah, S., Fabian, R. R., Clarke, L., Sahay, R. D., & Darbari, A. (2019) · The Journal of Pediatrics · doi:10.1016/j.jpeds.2018.09.048 · Cited by 10 · see citing works
Tseng, A. S., Traub, N. A., Harris, L. A., Crowell, M. D., Hoffman‐Snyder, C. R., Goodman, B. P., & DiBaise, J. K. (2018) · Journal of Parenteral and Enteral Nutrition · doi:10.1002/jpen.1493 · Cited by 10 · see citing works
Differences in cardiac autonomic function contributes to heart rate abnormalities in POTS and IST
Corkal, J. C., Palamarchuk, I. S., & Kimpinski, K. (2014) · Autonomic Neuroscience · doi:10.1016/j.autneu.2014.09.016 · Cited by 8 · see citing works
Fortunato, J. E., Laurienti, P. J., Wagoner, A. L., Shaltout, H. A., Diz, D. I., Silfer, J. L., & Burdette, J. H. (2021) · Neurogastroenterology & Motility · doi:10.1111/nmo.14271 · Cited by 6 · see citing works
Autonomic Nervous System and Disorders of Gut–Brain Interaction
Essner, B. S., Osgood, P. T., Pérez, M. E., & Fortunato, J. E. (2025) · Gastroenterology Clinics of North America · doi:10.1016/j.gtc.2025.05.002 · Cited by 6 · see citing works
Ives, C. T., & Kimpinski, K. (2014) · Clinical Neurophysiology · doi:10.1016/j.clinph.2014.02.014 · Cited by 6 · see citing works
Wolfson, S. M., Wilhelm, Z. R., Opekun, A. R., Orth, R. C., Shulman, R. J., & Chumpitazi, B. P. (2021) · Journal of Pediatric Gastroenterology and Nutrition · doi:10.1097/mpg.0000000000003089 · Cited by 6 · see citing works
Manini, M. L., Barazi, A., Khemani, D., Abd‐Rabu, R., Absah, I., Fischer, P. R., Mara, K. C., Stephens, M. C., & Camilleri, M. (2020) · Neurogastroenterology & Motility · doi:10.1111/nmo.13863 · Cited by 5 · see citing works
Self-citationBaker, J. R., & Kimpinski, K. (2015) · Physiology & Behavior · doi:10.1016/j.physbeh.2015.04.049 · Cited by 4 · see citing works
Are Functional Dyspepsia and Gastroparesis Separate Entities?
Kovacic, K. K., & Li, B. U. K. (2025) · Gastroenterology Clinics of North America · doi:10.1016/j.gtc.2025.02.002 · Cited by 2 · see citing works
Kulin, D., Shah, A., Fairlie, T., Staller, K. D., Nurko, S., Keefer, L., Aziz, Q., Drossman, D. A., Jones, M., & Holtmann, G. (2026) · Neurogastroenterology & Motility · doi:10.1111/nmo.70305 · Cited by 2 · see citing works
The Spectrum of Functional GI Disorders
Gamboa, H. E., & Sood, M. R. (2021) · Springer eBooks · doi:10.1007/978-3-030-80068-0_19 · Cited by 2 · see citing works
A prospective study of excessive postural heart rate change on head-up tilt
Corkal, J. C., & Kimpinski, K. (2014) · Clinical Autonomic Research · doi:10.1007/s10286-014-0254-x · Cited by 2 · see citing works
Stefi, E., Koch, K. L., Brown, A. L., & Shaltout, H. A. (2019) · Integrative Gastroenterology and Hepatology · doi:10.18314/igh.v2i1.1715 · Cited by 1 · see citing works
Autonomic Nervous System Testing
Chelimsky, G. G., & Chelimsky, T. C. (2016) · Springer eBooks · doi:10.1007/978-3-319-43268-7_16 · Cited by 1 · see citing works
Postural Tachycardia Syndrome and the Gut
Green, A., & Fikree, A. (2020) · Springer eBooks · doi:10.1007/978-3-030-54165-1_16
Autonomic Nervous System Testing
Chelimsky, G. G., & Chelimsky, T. C. (2022) · Springer eBooks · doi:10.1007/978-3-031-15229-0_18
Shin, A. (2025) · The American Journal of Gastroenterology · doi:10.14309/ajg.0000000000003609
Ishii, W. (2026) · Journal of Nihon University Medical Association · doi:10.4264/numa.85.2_51
- Authors
- Antiel, R. M., Risma, J. M., Grothe, R. M., Brands, C. K., & Fischer, P. R.
- Affiliations
- Department of Pediatric & Adolescent Medicine Division of General Pediatric and Adolescent Medicine Rochester Minnesota
- Mayo Clinic (US)
- Corresponding author
- Antiel, Ryan M
- Risma, Justin M
- Brands, Chad K
- Fischer, Philip R
- Venue
- Journal of Pediatric Gastroenterology and Nutrition
- Publisher
- Wiley
- Published
- 2008-03
- Volume
- 46
- Issue
- 3
- Pages
- 285-288
- ISSN
- 0277-2116 (ISSN-L)
- 1536-4801
- OpenAlex
- W1971392158
- Cited by
- 44
- References
- 23
- Citations by year
- 2026: 2 · 2025: 3 · 2022: 1 · 2021: 5 · 2020: 2 · 2019: 2 · 2018: 5 · 2016: 5 · 2015: 5 · 2014: 6 · 2013: 2 · 2012: 2
- FWCI
- 1.41
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Pediatric Gastroenterology and Nutrition (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Cardiovascular Syncope and Autonomic Disorders
- Health Sciences › Medicine › Gastroenterology › Gastrointestinal motility and disorders
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
- Keywords
- orthostatic intolerance, postural orthostatic tachycardia syndrome, gastric emptying, gastrointestinal motility, adolescents, nausea, abdominal pain, dyspepsia, autonomic function, tilt table test, delayed gastric emptying
- MeSH terms
- Adolescent, Child, Dizziness, Female, Gastric Emptying, Gastrointestinal Motility, Heart Rate, Humans, Male, Nausea, Predictive Value of Tests, Retrospective Studies, Sympathetic Nervous System, Tachycardia, Abdominal Pain, Case-Control Studies, Tilt-Table Test
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
