Share this article on:

Gastric Electrical Activity Becomes Abnormal in the Upright Position in Patients With Postural Tachycardia Syndrome

Safder, Shaista*; Chelimsky, Thomas C; O'Riordan, Mary Ann*; Chelimsky, Gisela*

Journal of Pediatric Gastroenterology & Nutrition: September 2010 - Volume 51 - Issue 3 - p 314–318
doi: 10.1097/MPG.0b013e3181d13623
Original Articles: Gastroenterology

Objectives: Some patients with functional abdominal pain report worsening of symptoms in the upright position. Many of these have a postural tachycardia syndrome (POTS). We investigated whether the electrical activity of the stomach changes during the upright portion of a tilt table test in patients with and without POTS.

Patients and Methods: All of the children undergoing autonomic testing were offered enrollment in this institutional review board–approved prospective study between October 2007 and January 2009. Electrogastrography was recorded 10 minutes in the supine position and during the entire upright portion of tilt. Children were divided into 2 groups: POTS and No-POTS. Findings were correlated with this grouping using Fisher exact test and either Student t test or Wilcoxon rank sum test as appropriate.

Results: Forty-nine patients participated (35 girls), with a mean age of 14.7 + 3.5 years, 25 with POTS and 24 without. The POTS and No-POTS groups did not differ in baseline normal gastric activity. The change from supine to standing showed a significant difference in the electrogastrographic tracing between the POTS and No-POTS groups (P < 0.04–0.09), best seen in channels 1 and 4. In particular, gastric activity became more abnormal in the upright position in the POTS group, whereas the opposite occurred in the No-POTS group.

Conclusions: The electrical activity of the stomach changes during the upright position in children with POTS, but not in children without this diagnosis. These changes could relate to their report of worsening pain in the upright position.

*Department of Pediatrics, USA

Department of Neurology, Case Western Reserve University School of Medicine, Rainbow Babies and Children's Hospital and Case Medical Center, Cleveland, Ohio, USA.

Received 23 July, 2009

Accepted 23 December, 2009

Address correspondence and reprint requests to Gisela Chelimsky, MD, 11100 Euclid Ave, Department of Pediatrics, University Hospitals of Cleveland, Cleveland, OH 44106 (e-mail:

Presented at the meetings of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (November 2008), World Congress of Pediatric Gastroenterology, Hepatology, and Nutrition (August 2008), and International Autonomic Society (November 2008), and accepted for presentation at the Neurogastroenterology and Motility Joint International meeting 2009.

The authors report no conflicts of interest.

Copyright 2010 by ESPGHAN and NASPGHAN