Disturbances of gastrointestinal transit and autonomic functions in postural orthostatic tachycardia syndrome
Open accessAbstract
Background: Gastrointestinal symptoms are common in the postural orthostatic tachycardia syndrome ( POTS ). However, few studies have evaluated gastrointestinal transit in POTS . Our primary objectives were to evaluate gastrointestinal emptying and the relationship with autonomic dysfunctions in POTS . Methods: We reviewed the complete medical records of all patients aged 18 years and older with POTS diagnosed by a standardized autonomic reflex screen who also had a scintigraphic assessment of gastrointestinal transit at Mayo Clinic Rochester between 1998 and 2012. Associations between specific gastric emptying and autonomic (i.e., cardiovagal, adrenergic, and sudomotor) disturbances were evaluated. Key Results: Among 163 patients (140 women, mean [± SEM ] age 30 [±1] years), 55 (34%) had normal, 30 (18%) had delayed, and 78 (48%) had rapid gastric emptying. Fifty‐eight patients (36%) had clinical features of physical deconditioning, which was associated ( p = 0.02) with rapid gastric emptying. Associations with delayed gastric emptying included vomiting, which was more common ( p < 0.003), and anxiety or depression, which was less common ( p = 0.02). The tilt‐associated increase in heart rate and reduction in systolic BP at 1 min was associated ( p < 0.05), being greater in patients with delayed gastric emptying. Conclusions & Inferences: Two‐thirds of patients with POTS and GI symptoms had abnormal, most frequently rapid gastric emptying. Except for more severe adrenergic impairment in patients with delayed gastric emptying, the pattern of autonomic dysfunction did not discriminate among gastric emptying groups. Further studies are necessary to ascertain whether extravascular volume depletion and/or deconditioning contribute to POTS in patients with gastrointestinal symptoms.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
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?
The majority of these patients had rapid gastric emptying, but a smaller subset had delayed gastric emptying.
“The majority of these patients had rapid gastric emptying, but a smaller subset had delayed gastric emptying (87);”
From Postural Orthostatic Tachycardia Syndrome (2019) · cites this paper as [87]
The Results (Demographic Features, Clinical Characteristics and Gastrointestinal Transit) report rapid gastric emptying in 78 of 163 patients (48%) and delayed emptying in 30 (18%). Rapid emptying was the most common finding, but 48% is not a majority of all patients. (LLM, conf=0.90)
Experimental — accuracy not yet measuredSeveral other studies have implicated dysmotility at different levels of the GI tract (duodenal, gastric) in POTS.
“Several other studies have implicated dysmotility at different levels of the GI tract (duodenal, gastric) in POTS (87)(88)(89).”
From Postural Orthostatic Tachycardia Syndrome (2019) · cites this paper as [87]
The Discussion reports abnormal gastric emptying in two-thirds of patients with POTS and GI symptoms, supporting the gastric part of the cited sentence. Although the paper also evaluated small-bowel transit, the passages do not establish duodenal dysmotility specifically. (LLM, conf=0.82)
Experimental — accuracy not yet measuredIn a retrospective study looking at GI transit in patients with POTS, two-thirds had abnormal gastric emptying.
“In a retrospective study looking at GI transit in patients with POTS, two-thirds had abnormal gastric emptying.”
From Postural Orthostatic Tachycardia Syndrome (2019) · cites this paper as [87]
Nearly 30% of POTS patients with GI symptoms have an abnormal QSART, a surrogate measure of post-ganglionic autonomic innervation.
“Loavenbruck et al. [39] and Park et al. [48] showed that nearly 30% of POTS patients with GI symptoms have an abnormal quantitative sudomotor axon reflex test (QSART), which is a surrogate measure of post-ganglionic autonomic innervation.”
From Gastrointestinal symptoms in postural tachycardia syndrome: a systematic review (2018) · cites this paper as [39]
Three studies reported that most POTS patients with GI symptoms have evidence of autonomic neuropathy.
“Three different studies reported that the majority of POTS patients with GI symptoms have evidence of autonomic neuropathy.”
From Gastrointestinal symptoms in postural tachycardia syndrome: a systematic review (2018) · cites this paper as [39]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
Physical activity, fitness, and health: international proceedings and consensus statement
(1994) · Choice Reviews Online · doi:10.5860/choice.32-0972 · Cited by 739 · see citing works
Physical activity, fitness and health : the model and key concepts
Bouchard, C., & Shephard, R. J. (1994) · Cited by 592 · see citing works
Postural orthostatic tachycardia syndrome: the Mayo clinic experience
Thieben, M. J., Sandroni, P., Sletten, D. M., Benrud-Larson, L. M., Fealey, R. D., Vernino, S., Low, P. A., Lennon, V. A., & Shen, W.-K. (2007) · Mayo Clinic Proceedings · doi:10.1016/s0025-6196(11)61027-6 · Cited by 516 · see citing works
Self-citationComposite Autonomic Scoring Scale for Laboratory Quantification of Generalized Autonomic Failure
Low, P. A. (1993) · Mayo Clinic Proceedings · doi:10.1016/s0025-6196(12)60631-4 · Cited by 466 · see citing works
Self-citationPostural tachycardia syndrome: a heterogeneous and multifactorial disorder
Benarroch, E. E. (2012) · Mayo Clinic Proceedings · doi:10.1016/j.mayocp.2012.08.013 · Cited by 370 · see citing works
Low, P. A., Denq, J.-C., Opfer‐Gehrking, T. L., Dyck, P. J., O’Brien, P. C., & Slezak, J. M. (1997) · Muscle & Nerve · doi:10.1002/(sici)1097-4598(199712)20:12 · Cited by 277 · see citing works
Self-citationTesting the Autonomic Nervous System
Low, P. A. (2003) · Seminars in Neurology · doi:10.1055/s-2004-817725 · Cited by 241 · see citing works
Self-citationCyclic Vomiting Syndrome in 41 adults: the illness, the patients, and problems of management
Fleisher, D. R., Gornowicz, B., Adams, K., Burch, R., & Feldman, E. J. (2005) · BMC Medicine · doi:10.1186/1741-7015-3-20 · Cited by 215 · see citing works
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-citationThe participation of the sympathetic innervation of the gastrointestinal tract in disease states
Lomax, A. E., Sharkey, K. A., & Furness, J. B. (2010) · Neurogastroenterology & Motility · doi:10.1111/j.1365-2982.2009.01381.x · Cited by 184 · see citing works
Camilleri, M., Iturrino, J., Bharucha, A. E., Burton, D. D., Shin, A., Jeong, I. D., & Zinsmeister, A. R. (2012) · Neurogastroenterology & Motility · doi:10.1111/j.1365-2982.2012.01972.x · Cited by 181 · see citing works
Self-citationRelationship between clinical features and gastric emptying disturbances in diabetes mellitus
Bharucha, A. E., Camilleri, M., Forstrom, L. A., & Zinsmeister, A. R. (2008) · Clinical Endocrinology · doi:10.1111/j.1365-2265.2008.03351.x · Cited by 146 · see citing works
Self-citationAutonomic 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
Self-citationNamin, F., Patel, J., Lin, Z., Sarosiek, I., Foran, P., Esmaeili, P., & Mccallum, R. (2007) · Neurogastroenterology & Motility · doi:10.1111/j.1365-2982.2006.00867.x · Cited by 129 · see citing works
Intestinal immune activation in presumed post‐infectious functional dyspepsia
Kindt, S., Tertychnyy, A. S., Hertogh, G. D., Geboes, K. J., & Tack, J. F. (2009) · Neurogastroenterology & Motility · doi:10.1111/j.1365-2982.2009.01299.x · Cited by 126 · see citing works
Deiteren, A., Camilleri, M., Bharucha, A. E., Burton, D. D., McKinzie, S., Rao, A. S., & Zinsmeister, A. R. (2009) · Neurogastroenterology & Motility · doi:10.1111/j.1365-2982.2009.01441.x · Cited by 111 · see citing works
Self-citationAutonomic abnormalities in cyclic vomiting syndrome
Chelimsky, T. C., & Chelimsky, G. G. (2007) · Journal of Pediatric Gastroenterology and Nutrition · doi:10.1097/mpg.0b013e31802bddb7 · Cited by 102 · see citing works
A prospective, 1-year follow-up study of postural tachycardia syndrome
Kimpinski, K., Figueroa, J. J., Singer, W., Sletten, D. M., Iodice, V., Sandroni, P., Fischer, P. R., Opfer-Gehrking, T. L., Gehrking, J. A., & Low, P. A. (2012) · Mayo Clinic Proceedings · doi:10.1016/j.mayocp.2012.02.020 · Cited by 81 · see citing works
Self-citationAutonomic 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
Rapid Gastric Emptying Is More Common than Gastroparesis in Patients With Autonomic Dysfunction
Lawal, A., Barboi, A., Krasnow, A., Hellman, R., Jaradeh, S., & Massey, B. T. (2007) · The American Journal of Gastroenterology · doi:10.1111/j.1572-0241.2006.00946.x · Cited by 66 · see citing works
Autonomic nerve function in adult patients with cyclic vomiting syndrome
Hejazi, R. A., Lavenbarg, T. H., Pasnoor, M., Dimachkie, M., Foran, P., Herbelin, L., & Mccallum, R. W. (2011) · Neurogastroenterology & Motility · doi:10.1111/j.1365-2982.2011.01679.x · Cited by 52 · see citing works
Gastrointestinal Dysfunction in Neurologic Disease
Camilleri, M., & Bharucha, A. (1996) · Seminars in neurology · doi:10.1055/s-2008-1040977 · Cited by 51 · see citing works
Self-citationGastric motor disturbances in patients with idiopathic rapid gastric emptying
Bharucha, A. E., Manduca, A., Lake, D. S., Fidler, J. L., Edwards, P. K., Grimm, R. C., Zinsmeister, A. R., & Riederer, S. J. (2011) · Neurogastroenterology & Motility · doi:10.1111/j.1365-2982.2011.01710.x · Cited by 50 · see citing works
Self-citationFujimura, J., Camilleri, M., Low, P. A., Novak, V., Novák, P., & Opfer‐Gehrking, T. L. (1997) · Journal of the Autonomic Nervous System · doi:10.1016/s0165-1838(97)00087-8 · Cited by 49 · see citing works
Self-citationGastric 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
Self-citationOrthostatic Intolerance and Gastrointestinal Motility in Adolescents With Nausea and Abdominal Pain
Antiel, R. M., Risma, J. M., Grothe, R. M., Brands, C. K., & Fischer, P. R. (2008) · Journal of Pediatric Gastroenterology and Nutrition · doi:10.1097/mpg.0b013e318145a70c · Cited by 44 · see citing works
Efferent pathways in the reflex control of gastric emptying in rats
Forster, E. R., Green, T., & Dockray, G. J. (1991) · American Journal of Physiology-Gastrointestinal and Liver Physiology · doi:10.1152/ajpgi.1991.260.3.g499 · Cited by 31 · see citing works
Andrews, C. N., Bharucha, A. E., Camilleri, M., Low, P. A., Seide, B. M., Burton, D. D., Nickander, K. K., Baxter, K. L., & Zinsmeister, A. R. (2007) · Neurogastroenterology & Motility · doi:10.1111/j.1365-2982.2007.00923.x · Cited by 26 · see citing works
Self-citationSafder, S., Chelimsky, T. C., O’Riordan, M. A., & Chelimsky, G. G. (2009) · Gastroenterology Research and Practice · doi:10.1155/2009/868496 · Cited by 24 · see citing works
Effect of tolterodine on gastrointestinal transit and bowel habits in healthy subjects
Bharucha, A. E., Seide, B. M., Guan, Z., et al. (2008) · Neurogastroenterology & Motility · doi:10.1111/j.1365-2982.2008.01089.x · Cited by 20 · see citing works
Self-citationBharucha, A. E., Skaar, T. C., Andrews, C. N., Camilleri, M., Philips, S., Seide, B. M., Burton, D. D., Baxter, K. L., & Zinsmeister, A. R. (2008) · Neurogastroenterology & Motility · doi:10.1111/j.1365-2982.2008.01124.x · Cited by 6 · see citing works
Self-citation
Flagged first, then by citations
Cited by
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
Autoimmune postural orthostatic tachycardia syndrome
Watari, M., Nakane, S., Mukaino, A., Nakajima, M., Mori, Y., Maeda, Y., Masuda, T., Takamatsu, K., Kouzaki, Y., Higuchi, O., et al. (2018) · Annals of Clinical and Translational Neurology · doi:10.1002/acn3.524 · Cited by 94 · see citing works
“Gastrointestinal (GI) disturbances are common and prolonged in patients with POTS, and it remains unknown whether extravascular volume depletion and deconditioning contribute to POTS in patients with other autonomic symptoms.(3,4) The pathophysiology of POTS is heterogeneous and includes impaired sympathetically-media…”
BackgroundBeckers, A. B., Keszthelyi, D., Fikree, A., Vork, L., Masclee, A., Farmer, A. D., & Aziz, Q. (2017) · Neurogastroenterology & Motility · doi:10.1111/nmo.13013 · Cited by 90 · see citing works
Evaluation of postural tachycardia syndrome (POTS)
Goodman, B. P. (2018) · Autonomic Neuroscience · doi:10.1016/j.autneu.2018.04.004 · Cited by 77 · 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
Alomari, M., Hitawala, A., Chadalavada, P., Covut, F., Al Momani, L., Khazaaleh, S., Gosai, F., Al Ashi, S., Abushahin, A., & Schneider, A. (2020) · Cureus · doi:10.7759/cureus.7881 · Cited by 53 · see citing works
“A large cohort study of 163 patients with POTS was evaluated, and 55 (34%) were found to have a normal gastric emptying time, 30 (18%) had a delayed or slowed gastric emptying time, and 78 (48%) were found to have rapid gastric emptying, suggesting that hEDS, autonomic symptoms, and GI symptoms are indeed linked, thou…”
BackgroundGastrointestinal dysfunction in postural tachycardia syndrome
Wang, L. B., Culbertson, C. J., Deb, A., Morgenshtern, K., Huang, H., & Hohler, A. D. (2015) · Journal of the Neurological Sciences · doi:10.1016/j.jns.2015.10.052 · Cited by 45 · see citing works
Fikree, A., Aziz, Q., & Sifrim, D. (2017) · Neurogastroenterology & Motility · doi:10.1111/nmo.13029 · Cited by 30 · see citing works
Kaufman, M. R., Chang‐Kit, L., Raj, S. R., Black, B. K., Milam, D. F., Reynolds, W. S., Biaggioni, I., Robertson, D., & Dmochowski, R. R. (2017) · Neurourology and Urodynamics · doi:10.1002/nau.22971 · Cited by 29 · see citing works
Aziz, Q., Harris, L. A., Goodman, B. P., Simrén, M., & Shin, A. (2025) · Clinical Gastroenterology and Hepatology · doi:10.1016/j.cgh.2025.02.015 · Cited by 27 · see citing works
Spectrum of gastrointestinal manifestations in joint hypermobility syndromes
Botrus, G., Baker, O., Borrego, E., Ngamdu, K. S., Teleb, M., Gonzales Martinez, J. L., Maldonado, G., Hussein, A. M., & McCallum, R. (2018) · The American Journal of the Medical Sciences · doi:10.1016/j.amjms.2018.03.001 · Cited by 26 · see citing works
Chakraborty, S., Halland, M., Burton, D., Desai, A., Neja, B., Low, P., Singer, W., Camilleri, M., Zinsmeister, A. R., & Bharucha, A. E. (2019) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2018-01623 · Cited by 23 · see citing works
Lam, C., Amarasinghe, G., Zarate-Lopez, N., Fikree, A., Byrne, P., Kiani-Alikhan, S., Gabe, S., & Paine, P. (2023) · Frontline Gastroenterology · doi:10.1136/flgastro-2022-102088 · Cited by 23 · 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
Loganathan, P., Herlihy, D., Gajendran, M., Gonzalez, Z., Chavez, L. O., Espino, K., & McCallum, R. W. (2024) · Journal of Investigative Medicine · doi:10.1177/10815589231210486 · Cited by 8 · see citing works
- Authors
- Loavenbruck, A., Iturrino, J., Singer, W., Sletten, D. M., Low, P. A., Zinsmeister, A. R., & Bharucha, A. E.
- Affiliations
- Mayo Clinic (US)
- Corresponding author
- Bharucha, A. E.
- Venue
- Neurogastroenterology & Motility
- Publisher
- Wiley
- Published
- 2014-12-06
- Volume
- 27
- Issue
- 1
- Pages
- 92-98
- ISSN
- 1350-1925 (ISSN-L)
- 1365-2982
- PMC
- PMC4286289
- OpenAlex
- W2003403827
- Cited by
- 63
- References
- 31
- Citations by year
- 2026: 4 · 2025: 5 · 2024: 5 · 2023: 3 · 2022: 4 · 2021: 4 · 2020: 10 · 2019: 6 · 2018: 12 · 2017: 5 · 2016: 3 · 2015: 1 · 2012: 1
- FWCI
- 2.97
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Neurogastroenterology & Motility (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institue of Health (P01 DK068055, NS44233, U54NSO65736, and UL1 TR000135)
- 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
- postural orthostatic tachycardia syndrome, gastrointestinal transit, gastric emptying, autonomic dysfunction, adrenergic dysfunction, sudomotor dysfunction, deconditioning, vomiting, tilt table test, gastrointestinal symptoms
- MeSH terms
- Adult, Autonomic Nervous System, Female, Gastrointestinal Transit, Humans, Male, Gastroparesis, Postural Orthostatic Tachycardia Syndrome
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
