{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T23:44:40Z","timestamp":1792626280588,"version":"4.5.0"},"reference-count":54,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2024,1,29]],"date-time":"2024-01-29T00:00:00Z","timestamp":1706486400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Physiol."],"abstract":"<jats:p>\n                    Gastrointestinal (GI) symptoms are common in postural orthostatic tachycardia syndrome (POTS). We aimed to explore the prevalence and severity of GI symptoms in POTS, and to investigate immunological factors, hemodynamic findings, and their possible association with GI symptoms in POTS. Forty-three patients (93% female, median age 30.6 (26.0\u201341.0) years), previously diagnosed with POTS and 74 healthy controls (78% female, median age 35.6 (28.8\u201341.7)\u00a0years) were included. The participants completed a questionnaire including prevalence of GI symptoms, the irritable bowel syndrome severity scoring system (IBS-SSS), and visual analog scale for IBS (VAS-IBS). All POTS patients were previously examined by tilt test (2010\u20132021) and the vast majority with more recent active standing test (2017\u20132021), which included monitoring of heart rate (HR). \u0394HR was calculated as difference between supine and upright position. Continuous variables from IBS-SSS and VAS-IBS were correlated to \u0394HR. A microarray containing several autoantigens commonly targeted in systemic autoimmune disorders was used to assess prevalent autoantibodies in POTS and controls. Total IgE and S-tryptase were analyzed. GI symptoms were more prevalent and severe in POTS than in controls; nausea being the most prevalent (79.1% vs 4.9%,\n                    <jats:italic>p<\/jats:italic>\n                    &amp;lt; 0.001) and bloating and flatulence being the most severe (median 65 (25\u201388) vs 0 (0\u201314),\n                    <jats:italic>p<\/jats:italic>\n                    &amp;lt; 0.001). The median total IBS-SSS was 213 (135\u2013319) in POTS vs 13 (0\u201354) in controls (\n                    <jats:italic>p<\/jats:italic>\n                    &amp;lt; 0.001). Total IBS-SSS was associated with low psychological wellbeing (r = 0.539,\n                    <jats:italic>p<\/jats:italic>\n                    &amp;lt; 0.001) in POTS. \u0394HR\n                    <jats:sub>max<\/jats:sub>\n                    correlated inversely with abdominal pain (r = \u22120.406,\n                    <jats:italic>p<\/jats:italic>\n                    = 0.007). After adjustments for psychological wellbeing, total IBS-SSS still associated inversely with \u0394HR\n                    <jats:sub>10min<\/jats:sub>\n                    (\u03b2: 4.748; 95% CI: \u22129.172 to \u22120.324;\n                    <jats:italic>p<\/jats:italic>\n                    = 0.036). Similar results were seen with active standing test. The prevalence of autoantibodies did not differ between POTS and controls (29.4% vs 33.3%,\n                    <jats:italic>p<\/jats:italic>\n                    = 0.803). There was no association between GI symptoms and autoantibody status. Total IgE and tryptase were elevated in a few cases. This study confirms the high prevalence of GI symptoms in POTS. More pronounced tachycardia upon tilt table testing seems to be inversely correlated with severity of chronic GI symptoms in POTS. This study did not support the hypothesis that POTS is associated with immunological factors.\n                  <\/jats:p>","DOI":"10.3389\/fphys.2024.1342351","type":"journal-article","created":{"date-parts":[[2024,1,28]],"date-time":"2024-01-28T23:24:13Z","timestamp":1706484253000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":10,"title":["Gastrointestinal symptoms in patients with postural orthostatic tachycardia syndrome in relation to hemodynamic findings and immunological factors"],"prefix":"10.3389","volume":"15","author":[{"given":"Hanna","family":"Tufvesson","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Viktor","family":"Hamrefors","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Artur","family":"Fedorowski","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monika","family":"Hansson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bodil","family":"Ohlsson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2024,1,29]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"219","DOI":"10.1007\/s10286-005-0282-7","article-title":"The value of autonomic testing in postural tachycardia syndrome","volume":"15","author":"Al-Shekhlee","year":"2005","journal-title":"Clin. Auton. Res."},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1111\/nmo.13013","article-title":"Gastrointestinal disorders in joint hypermobility syndrome\/Ehlers-Danlos syndrome hypermobility type: a review for the gastroenterologist","volume":"29","author":"Beckers","year":"2017","journal-title":"Neurogastroenterol. Motil."},{"key":"B3","doi-asserted-by":"publisher","first-page":"1214","DOI":"10.1016\/j.mayocp.2012.08.013","article-title":"Postural tachycardia syndrome: a heterogeneous and multifactorial disorder","volume":"87","author":"Benarroch","year":"2012","journal-title":"Mayo Clin. Proc."},{"key":"B4","doi-asserted-by":"publisher","first-page":"16","DOI":"10.1186\/1471-230x-7-16","article-title":"Development and psychometric testing of the visual analogue scale for irritable bowel syndrome (VAS-IBS)","volume":"7","author":"Bengtsson","year":"2007","journal-title":"BMC Gastroenterol."},{"key":"B5","doi-asserted-by":"publisher","first-page":"1364","DOI":"10.1177\/0961203315587566","article-title":"Autoimmune markers and autoimmune disorders in patients with postural tachycardia syndrome (POTS)","volume":"24","author":"Blitshteyn","year":"2015","journal-title":"Lupus"},{"key":"B6","doi-asserted-by":"publisher","first-page":"1883","DOI":"10.1093\/eurheartj\/ehy037","article-title":"2018 ESC Guidelines for the diagnosis and management of syncope","volume":"39","author":"Brignole","year":"2018","journal-title":"Eur. Heart J."},{"key":"B7","doi-asserted-by":"publisher","first-page":"e143771","DOI":"10.1172\/jci143771","article-title":"Gastrointestinal motility disorders in neurologic disease","volume":"131","author":"Camilleri","year":"2021","journal-title":"J. Clin. Invest"},{"key":"B8","doi-asserted-by":"publisher","first-page":"149","DOI":"10.1111\/j.1365-2982.2008.01171.x","article-title":"Dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis in irritable bowel syndrome","volume":"21","author":"Chang","year":"2009","journal-title":"Neurogastroenterol. Motil."},{"key":"B9","doi-asserted-by":"publisher","first-page":"70","DOI":"10.1016\/j.autneu.2018.09.003","article-title":"The gastrointestinal symptoms present in patients with postural tachycardia syndrome: a review of the literature and overview of treatment","volume":"215","author":"Chelimsky","year":"2018","journal-title":"Auton. Neurosci."},{"key":"B10","doi-asserted-by":"publisher","first-page":"120","DOI":"10.1016\/j.jpeds.2015.03.039","article-title":"Comorbid conditions do not differ in children and young adults with functional disorders with or without postural tachycardia syndrome","volume":"167","author":"Chelimsky","year":"2015","journal-title":"J. Pediatr."},{"key":"B11","doi-asserted-by":"publisher","first-page":"1458","DOI":"10.1038\/s41395-018-0215-4","article-title":"Postural tachycardia syndrome (POTS) and the GI tract: a primer for the gastroenterologist","volume":"113","author":"DiBaise","year":"2018","journal-title":"Am. J. Gastroenterol."},{"key":"B12","doi-asserted-by":"publisher","first-page":"111","DOI":"10.1016\/j.sjpain.2015.12.005","article-title":"Definition, diagnosis and treatment strategies for opioid-induced bowel dysfunction-Recommendations of the Nordic Working Group","volume":"11","author":"Drewes","year":"2016","journal-title":"Scand. J. Pain"},{"key":"B13","doi-asserted-by":"publisher","first-page":"1235","DOI":"10.1111\/j.1464-5491.2007.02236.x","article-title":"Oesophageal dysmotility, delayed gastric emptying and gastrointestinal symptoms in patients with diabetes mellitus","volume":"24","author":"Faraj","year":"2007","journal-title":"Diabet. Med."},{"key":"B14","doi-asserted-by":"publisher","first-page":"352","DOI":"10.1111\/joim.12852","article-title":"Postural orthostatic tachycardia syndrome: clinical presentation, aetiology and management","volume":"285","author":"Fedorowski","year":"2019","journal-title":"J. Intern Med."},{"key":"B15","doi-asserted-by":"publisher","first-page":"359","DOI":"10.1111\/joim.12043","article-title":"Novel cardiovascular biomarkers in unexplained syncopal attacks: the SYSTEMA cohort","volume":"273","author":"Fedorowski","year":"2013","journal-title":"J. Intern Med."},{"key":"B16","doi-asserted-by":"publisher","first-page":"29","DOI":"10.1111\/nmo.13029","article-title":"Mechanisms underlying reflux symptoms and dysphagia in patients with joint hypermobility syndrome, with and without postural tachycardia syndrome","volume":"29","author":"Fikree","year":"2017","journal-title":"Neurogastroenterol. Motil."},{"key":"B17","doi-asserted-by":"publisher","first-page":"1675","DOI":"10.1016\/S0140-6736(20)31548-8","article-title":"Irritable bowel syndrome","volume":"396","author":"Ford","year":"2020","journal-title":"Lancet"},{"key":"B18","doi-asserted-by":"publisher","first-page":"39","DOI":"10.1097\/MPG.0000000000000305","article-title":"Effect of fludrocortisone acetate on chronic unexplained nausea and abdominal pain in children with orthostatic intolerance","volume":"59","author":"Fortunato","year":"2014","journal-title":"J. Pediatr. Gastroenterol. Nutr."},{"key":"B19","doi-asserted-by":"publisher","first-page":"395","DOI":"10.1046\/j.1365-2036.1997.142318000.x","article-title":"The irritable bowel severity scoring system: a simple method of monitoring irritable bowel syndrome and its progress","volume":"11","author":"Francis","year":"1997","journal-title":"Aliment. Pharmacol. Ther."},{"key":"B20","doi-asserted-by":"publisher","first-page":"407","DOI":"10.1016\/B978-0-444-64032-1.00027-8","article-title":"Basics of autonomic nervous system function","volume":"160","author":"Gibbons","year":"2019","journal-title":"Handb. Clin. Neurol."},{"key":"B21","doi-asserted-by":"publisher","first-page":"e84716","DOI":"10.1371\/journal.pone.0084716","article-title":"Structural and functional small fiber abnormalities in the neuropathic postural tachycardia syndrome","volume":"8","author":"Gibbons","year":"2013","journal-title":"PLoS One"},{"key":"B22","doi-asserted-by":"publisher","first-page":"R201","DOI":"10.1186\/ar4039","article-title":"Validation of a multiplex chip-based assay for the detection of autoantibodies against citrullinated peptides","volume":"14","author":"Hansson","year":"2012","journal-title":"Arthritis Res. Ther."},{"key":"B23","doi-asserted-by":"publisher","first-page":"3207","DOI":"10.1007\/s10620-013-2865-9","article-title":"Manometric abnormalities in the postural orthostatic tachycardia syndrome: a case series","volume":"58","author":"Huang","year":"2013","journal-title":"Dig. Dis. Sci."},{"key":"B24","doi-asserted-by":"publisher","first-page":"103","DOI":"10.1515\/jbcpp-2022-0069","article-title":"Resting heart rate variability as a diagnostic marker of cardiovascular dysautonomia in postural tachycardia syndrome","volume":"34","author":"Inbaraj","year":"2023","journal-title":"J. Basic Clin. Physiol. Pharmacol."},{"key":"B25","doi-asserted-by":"publisher","first-page":"8575","DOI":"10.1038\/s41598-021-87983-5","article-title":"Circulating levels of growth hormone in postural orthostatic tachycardia syndrome","volume":"11","author":"Johansson","year":"2021","journal-title":"Sci. Rep."},{"key":"B26","doi-asserted-by":"publisher","first-page":"750","DOI":"10.1111\/j.1540-8159.2011.03047.x","article-title":"Pyridostigmine in the treatment of postural orthostatic tachycardia: a single-center experience","volume":"34","author":"Kanjwal","year":"2011","journal-title":"Pacing Clin. Electrophysiol."},{"key":"B27","doi-asserted-by":"publisher","first-page":"371","DOI":"10.1007\/s10286-006-0365-0","article-title":"Experimental induction of panic-like symptoms in patients with postural tachycardia syndrome","volume":"16","author":"Khurana","year":"2006","journal-title":"Clin. Auton. Res."},{"key":"B28","doi-asserted-by":"publisher","first-page":"e021002","DOI":"10.1161\/jaha.121.021002","article-title":"Mast cell activation disorder and postural orthostatic tachycardia syndrome: a clinical association","volume":"10","author":"Kohno","year":"2021","journal-title":"J. Am. Heart Assoc."},{"key":"B29","doi-asserted-by":"publisher","first-page":"1284","DOI":"10.1136\/gutjnl-2011-300474","article-title":"The brain--gut pathway in functional gastrointestinal disorders is bidirectional: a 12-year prospective population-based study","volume":"61","author":"Koloski","year":"2012","journal-title":"Gut"},{"key":"B30","unstructured":"Region Sk\u00e5ne, analysportalen: immunoglobulin E (total IgE)"},{"key":"B31","unstructured":"Region Sk\u00e5ne, analysportalen: tryptas"},{"key":"B32","doi-asserted-by":"publisher","first-page":"895","DOI":"10.1016\/j.jpain.2009.06.012","article-title":"Central sensitization: a generator of pain hypersensitivity by central neural plasticity","volume":"10","author":"Latremoliere","year":"2009","journal-title":"J. Pain"},{"key":"B33","doi-asserted-by":"publisher","first-page":"783","DOI":"10.3969\/j.issn.1671-167X.2017.05.007","article-title":"Co-morbidity of vasovagal syncope and postural tachycardia syndrome with allergic diseases in children","volume":"49","author":"Liao","year":"2017","journal-title":"Beijing Da Xue Xue Bao Yi Xue Ban."},{"key":"B34","doi-asserted-by":"publisher","first-page":"92","DOI":"10.1111\/nmo.12480","article-title":"Disturbances of gastrointestinal transit and autonomic functions in postural orthostatic tachycardia syndrome","volume":"27","author":"Loavenbruck","year":"2015","journal-title":"Neurogastroenterol. Motil."},{"key":"B35","doi-asserted-by":"publisher","first-page":"352","DOI":"10.1111\/j.1540-8167.2008.01407.x","article-title":"Postural tachycardia syndrome (POTS)","volume":"20","author":"Low","year":"2009","journal-title":"J. Cardiovasc Electrophysiol."},{"key":"B36","doi-asserted-by":"publisher","first-page":"e12982","DOI":"10.1016\/j.heliyon.2023.e12982","article-title":"Sex adjusted standardized prevalence ratios for celiac disease and other autoimmune diseases in patients with postural orthostatic tachycardia syndrome (POTS): a systematic review and meta-analysis","volume":"9","author":"Mannan","year":"2023","journal-title":"Heliyon"},{"key":"B37","doi-asserted-by":"publisher","first-page":"399","DOI":"10.1097\/MCG.0000000000001181","article-title":"Conditioned pain modulation (cpm) is reduced in irritable bowel syndrome: a systematic review and meta-analysis of cpm and the role of psychological factors","volume":"53","author":"Marcuzzi","year":"2019","journal-title":"J. Clin. Gastroenterol."},{"key":"B38","doi-asserted-by":"publisher","first-page":"411","DOI":"10.1007\/s10286-018-0519-x","article-title":"Gastrointestinal symptoms in postural tachycardia syndrome: a systematic review","volume":"28","author":"Mehr","year":"2018","journal-title":"Clin. Auton. Res."},{"key":"B39","doi-asserted-by":"publisher","first-page":"102637","DOI":"10.1016\/j.autneu.2020.102637","article-title":"Prevalence of hypermobile Ehlers-Danlos syndrome in postural orthostatic tachycardia syndrome","volume":"224","author":"Miller","year":"2020","journal-title":"Auton. Neurosci."},{"key":"B40","doi-asserted-by":"publisher","first-page":"17562848221114558","DOI":"10.1177\/17562848221114558","article-title":"Extraintestinal manifestations in irritable bowel syndrome: a systematic review","volume":"15","author":"Ohlsson","year":"2022","journal-title":"Ther. Adv. Gastroenterol."},{"key":"B41","doi-asserted-by":"publisher","first-page":"143","DOI":"10.1097\/SPC.0000000000000055","article-title":"Descending pain modulation and chronification of pain","volume":"8","author":"Ossipov","year":"2014","journal-title":"Curr. Opin. Support Palliat. Care"},{"key":"B42","doi-asserted-by":"publisher","first-page":"163","DOI":"10.1007\/s10286-013-0193-y","article-title":"Gastric emptying in postural tachycardia syndrome: a preliminary report","volume":"23","author":"Park","year":"2013","journal-title":"Clin. Auton. Res."},{"key":"B43","doi-asserted-by":"publisher","first-page":"E378","DOI":"10.1503\/cmaj.211373","article-title":"Diagnosis and management of postural orthostatic tachycardia syndrome","volume":"194","author":"Raj","year":"2022","journal-title":"Cmaj"},{"key":"B44","doi-asserted-by":"publisher","first-page":"46","DOI":"10.1016\/j.autneu.2018.03.004","article-title":"Cognitive and psychological issues in postural tachycardia syndrome","volume":"215","author":"Raj","year":"2018","journal-title":"Auton. Neurosci."},{"key":"B45","doi-asserted-by":"publisher","first-page":"91","DOI":"10.1111\/joim.13566","article-title":"Malm\u00f6 POTS symptom score: assessing symptom burden in postural orthostatic tachycardia syndrome","volume":"293","author":"Spahic","year":"2023","journal-title":"J. Intern Med."},{"key":"B46","doi-asserted-by":"publisher","first-page":"425","DOI":"10.1097\/01.mpg.0000157914.40088.31","article-title":"Gastrointestinal symptoms associated with orthostatic intolerance","volume":"40","author":"Sullivan","year":"2005","journal-title":"J. Pediatr. Gastroenterol. Nutr."},{"key":"B47","doi-asserted-by":"publisher","first-page":"e13975","DOI":"10.1111\/nmo.13975","article-title":"Functional gastrointestinal disorders are increased in joint hypermobility-related disorders with concomitant postural orthostatic tachycardia syndrome","volume":"32","author":"Tai","year":"2020","journal-title":"Neurogastroenterol. Motil."},{"key":"B48","doi-asserted-by":"publisher","first-page":"e14031","DOI":"10.1111\/nmo.14031","article-title":"Mechanisms and management of gastrointestinal symptoms in postural orthostatic tachycardia syndrome","volume":"32","author":"Tu","year":"2020","journal-title":"Neurogastroenterol. Motil."},{"key":"B49","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1155\/2023\/3992718","article-title":"Sociodemographic factors, nutritional status, and inflammatory markers in patients with postural orthostatic tachycardia syndrome","volume":"2023","author":"Tufvesson","year":"2023","journal-title":"Acta Neurol. Scand."},{"key":"B50","doi-asserted-by":"publisher","first-page":"3010","DOI":"10.1016\/j.jaip.2023.08.008","article-title":"The normal range of baseline tryptase should Be 1 to 15 ng\/mL and covers healthy individuals with H\u03b1T","volume":"11","author":"Valent","year":"2023","journal-title":"J. Allergy Clin. Immunol. Pract."},{"key":"B51","doi-asserted-by":"publisher","first-page":"102828","DOI":"10.1016\/j.autneu.2021.102828","article-title":"Postural orthostatic tachycardia syndrome (POTS): state of the science and clinical care from a 2019 national institutes of health expert consensus meeting - Part 1","volume":"235","author":"Vernino","year":"2021","journal-title":"Auton. Neurosci."},{"key":"B52","doi-asserted-by":"publisher","first-page":"78","DOI":"10.1016\/j.autneu.2018.04.005","article-title":"Autoimmunity in postural orthostatic tachycardia syndrome: current understanding","volume":"215","author":"Vernino","year":"2018","journal-title":"Auton. Neurosci."},{"key":"B53","doi-asserted-by":"publisher","first-page":"193","DOI":"10.1016\/j.jns.2015.10.052","article-title":"Gastrointestinal dysfunction in postural tachycardia syndrome","volume":"359","author":"Wang","year":"2015","journal-title":"J. Neurol. Sci."},{"key":"B54","doi-asserted-by":"publisher","first-page":"454","DOI":"10.1016\/j.pain.2009.12.005","article-title":"Central and peripheral hypersensitivity in the irritable bowel syndrome","volume":"148","author":"Zhou","year":"2010","journal-title":"Pain"}],"container-title":["Frontiers in Physiology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fphys.2024.1342351\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,1,28]],"date-time":"2024-01-28T23:24:18Z","timestamp":1706484258000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fphys.2024.1342351\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,1,29]]},"references-count":54,"alternative-id":["10.3389\/fphys.2024.1342351"],"URL":"https:\/\/doi.org\/10.3389\/fphys.2024.1342351","relation":{},"ISSN":["1664-042X"],"issn-type":[{"value":"1664-042X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,1,29]]},"article-number":"1342351"}}