Gastrointestinal Symptoms Associated with Orthostatic Intolerance

Abstract

Pediatric patients with chronic upper gastrointestinal symptoms may have underlying orthostatic intolerance. In patients with upper gastrointestinal symptoms and orthostatic intolerance, treatment of orthostatic intolerance may result in resolution of gastrointestinal symptoms.

Fludrocortisone improves nausea in children with orthostatic intolerance (OI)

“…Our results are consistent with those of Sullivan et al [4] in which 78% of pediatric patients with upper gastrointestinal symptoms (including abdominal pain and nausea) and OI experienced complete resolution of gastrointestinal symptoms when NMH or POTS was treated. A recent study suggested that the diagnostic criteria for OI/POTS in adults may be inadequate for children and that an increase in heart rate greater than 45 bpm may be a more appropriate cutoff to define POTS [5].…”

Clinical Presentation and Pathophysiology of Gastroparesis

“…Patients with orthostatic intolerance frequently have chronic GI complaints, most commonly abdominal pain, nausea, and vomiting. 30 However, the nausea often resolves with treatment of the orthostasis. Autonomic dysfunction can cause symptoms by altering either afferent or efferent pathways.…”

Autonomic Testing in Functional Gastrointestinal Disorders: Implications of Reproducible Gastrointestinal Complaints during Tilt Table Testing

“…A role for abnormal autonomic nervous system function is increasingly recognized which may not be limited to the gastrointestinal tract. In pediatrics, exploratory studies have found autonomic dysregulation in pediatric FGID [4–6]. FGID's have been associated with orthostatic intolerance (OI), mainly postural tachycardia syndrome (POTS) and syncope [4, 6], but other associations have not been carefully evaluated.…”

“…In pediatrics, exploratory studies have found autonomic dysregulation in pediatric FGID [4–6]. FGID's have been associated with orthostatic intolerance (OI), mainly postural tachycardia syndrome (POTS) and syncope [4, 6], but other associations have not been carefully evaluated. Three main types of orthostatic disorders have been described in patients undergoing tilt table testing (TTT): postural tachycardia syndrome (POTS), reflex syncope, and orthostatic hypotension (OH).…”