A unique case of GI disorders manifesting as pots

Document Type

Conference Proceeding

Publication Date


Publication Title

Am J Gastroenterol


Introduction: Postural orthostatic tachycardia syndrome (POTS) is a disorder causing dizziness, palpitations, nausea, lightheadedness and orthostatic tachycardia that resolve with seated or supine position. It is associated with GI symptoms including nausea, abdominal pain, and bloating. We present a case of a young female presenting with a myriad of GI complaints who was diagnosed with POTS. Case Description/Methods: A 19 y.o. female with history of anxiety and migraines presented to GI clinic for progressive nausea, epigastric abdominal pain, early satiety, alternating diarrhea and constipation, and weight loss. The symptoms began four years ago after a viral infection. Symptoms were initially attributed to functional dyspepsia and anxiety. She denied dysphagia, odyonophagia, dizziness, vertigo. Lab workup including CBC, CMP, CRP, amylase, lipase, TTG IgA, HIV, Hepatitis labs, UA, were negative. ANA was positive and referred to rheumatology, however further workup for autoimmune disease was negative. Imaging including CT Abdomen, CT Angiography, and RUQ US were negative to rule out acute abdominal processes, mesenteric ischemia, and biliary pathology, respectively. MRI brain was normal. Gastric emptying study was normal. An outpatient EGD was attempted however the patient had sustained narrow complex tachycardia with heart rate in the 120- 160s. The patient was diagnosed with inappropriate sinus tachycardia. Colonoscopy and EGD were normal. Patient followed up with cardiologist for diagnosis of inappropriate tachycardia and was subsequently diagnosed with POTS through tilt table testing. Discussion: This case illustrates the importance of exploring secondary causes of GI symptoms when workup for a primary GI disorder is otherwise negative. In our patient, initial symptoms began after a viral infection and POTS frequently appears after a trigger such as a viral infection. She also exhibited the most common GI symptoms in POTS including nausea, diarrhea, constipation, abdominal pain, and bloating. She did not have delayed gastric emptying compared to others with POTS. In one study, Loavenbruck et al. Found 34% of 163 POTS patients had normal gastric emptying, 18% with delayed, and 48% with rapid gastric emptying. In our patient, it was evident that secondary disorders caused GI symptoms and required further diagnostic testing outside the realm of gastroenterology. Therefore, increased awareness of the relationship between POTS and GI complaints is essential for a practicing gastroenterologist.

PubMed ID

Not assigned.





First Page