{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T02:14:38Z","timestamp":1790302478057,"version":"4.1.0"},"reference-count":43,"publisher":"Public Library of Science (PLoS)","issue":"7","license":[{"start":{"date-parts":[[2025,7,3]],"date-time":"2025-07-03T00:00:00Z","timestamp":1751500800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Inger and Sverker Perssons Foundation"},{"name":"Research and Development Foundation of Region Sk\u00e5ne","award":["2022-0067"],"award-info":[{"award-number":["2022-0067"]}]},{"name":"Research and Development Foundation of Region Sk\u00e5ne","award":["2022-0129"],"award-info":[{"award-number":["2022-0129"]}]},{"DOI":"10.13039\/501100011077","name":"Sk\u00e5ne University Hospital","doi-asserted-by":"crossref","award":["2022-882"],"award-info":[{"award-number":["2022-882"]}],"id":[{"id":"10.13039\/501100011077","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100011077","name":"Sk\u00e5ne University Hospital","doi-asserted-by":"crossref","award":["2022-974"],"award-info":[{"award-number":["2022-974"]}],"id":[{"id":"10.13039\/501100011077","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100004359","name":"Swedish Research Council","doi-asserted-by":"crossref","award":["2021-01942"],"award-info":[{"award-number":["2021-01942"]}],"id":[{"id":"10.13039\/501100004359","id-type":"DOI","asserted-by":"crossref"}]},{"name":"Elly Olsson's foundation for scientific research"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Aim<\/jats:title>\n<jats:p>Postural orthostatic tachycardia syndrome (POTS) is a disorder with cardiovascular autonomic dysfunction where multiple and variable symptoms are common, including those from the peripheral and enteric nervous systems. We aimed to investigate subjective and objective signs of small and large fiber neuropathy in a Swedish POTS cohort compared with healthy controls. Secondly, we wanted to examine potential associations between gastrointestinal symptoms and neuropathy signs in POTS.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>Forty-three patients with POTS (93% female) and 54 healthy controls (76% female) were included in the study. All participants completed a questionnaire including modified neuropathy symptoms score (NSS) and irritable bowel syndrome severity scoring system (IBS-SSS) for gastrointestinal evaluation. Small nerve fibers were investigated by assessing the intraepidermal nerve fiber density (IENFD). Large nerve fiber function was examined through pinprick and vibration perception thresholds (VPTs), using neurothesiometry and multi-frequency vibrometry (MFV). The patients were classified as \u201cHigh NSS\u201d and \u201cHigh IBS-SSS\u201d if their total NSS vs. IBS-SSS were above median levels in POTS.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>Peripheral sensory and gastrointestinal symptoms were more prevalent and severe in POTS than in controls. Median VPTs were normal and IENFDs were comparable between POTS and controls (2.26 [1.62\u20133.08] vs. 1.63 [0.73\u20132.68] fibers\/mm; p\u2009=\u20090.108). The patients with \u201chigh NSS\u201d had slightly higher VPTs measured by MFV, although within normal ranges, compared to patients with \u201clow NSS\u201d. The patients within the \u201chigh IBS-SSS\u201d group had higher NSS (18.0 [14.3\u201322.8] vs. 11.0 [4.0\u201315.0]; p\u2009=\u20090.002) compared to patients with low total IBS-SSS.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>Symptoms of peripheral and enteric neuropathy are common in POTS but no solid evidence was found regarding functional or morphological signs of small or large fiber neuropathy. Neuropathic and gastrointestinal symptoms were closely associated within POTS.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0327549","type":"journal-article","created":{"date-parts":[[2025,7,3]],"date-time":"2025-07-03T17:36:29Z","timestamp":1751564189000},"page":"e0327549","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":2,"title":["Symptoms and objective signs of peripheral sensory neuropathy in POTS and correlations to gastrointestinal symptoms"],"prefix":"10.1371","volume":"20","author":[{"given":"Linn\u00e9a","family":"Ekman","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8789-8903","authenticated-orcid":true,"given":"Hanna","family":"Tufvesson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisabet","family":"Englund","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lars B.","family":"Dahlin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9142-5244","authenticated-orcid":true,"given":"Bodil","family":"Ohlsson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,7,3]]},"reference":[{"issue":"4","key":"pone.0327549.ref001","doi-asserted-by":"crossref","first-page":"352","DOI":"10.1111\/joim.12852","article-title":"Postural orthostatic tachycardia syndrome: clinical presentation, aetiology and management","volume":"285","author":"A Fedorowski","year":"2019","journal-title":"J Intern Med"},{"issue":"12","key":"pone.0327549.ref002","doi-asserted-by":"crossref","first-page":"1214","DOI":"10.1016\/j.mayocp.2012.08.013","article-title":"Postural tachycardia syndrome: a heterogeneous and multifactorial disorder","volume":"87","author":"EE Benarroch","year":"2012","journal-title":"Mayo Clin Proc"},{"issue":"14","key":"pone.0327549.ref003","doi-asserted-by":"crossref","first-page":"1008","DOI":"10.1056\/NEJM200010053431404","article-title":"The neuropathic postural tachycardia syndrome","volume":"343","author":"G Jacob","year":"2000","journal-title":"N Engl J Med"},{"issue":"2","key":"pone.0327549.ref004","doi-asserted-by":"crossref","first-page":"185","DOI":"10.3233\/JND-200490","article-title":"Current view of diagnosing small fiber neuropathy","volume":"8","author":"LRM Raasing","year":"2021","journal-title":"J Neuromuscul Dis"},{"issue":"1","key":"pone.0327549.ref005","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1002\/ccr3.2575","article-title":"Autonomic and peripheral neuropathy with reduced intraepidermal nerve fiber density can be observed in patients with gastrointestinal dysmotility","volume":"8","author":"B Ohlsson","year":"2019","journal-title":"Clin Case 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