Key result
Postural orthostatic tachycardia syndrome was associated with severe peripheral sensory and gastrointestinal symptoms, but no significant differences in objective signs of neuropathy like intraepidermal nerve fiber density were found compared to healthy controls.
Why the study?
POTS involves cardiovascular autonomic dysfunction with frequent peripheral and enteric nervous system symptoms, but subjective and objective signs of small and large fiber neuropathy and their potential links to gastrointestinal symptoms required investigation.
Cross-Sectional (n=97)
No
Despite experiencing significant self-reported sensory and gastrointestinal neuropathic symptoms, patients with POTS did not exhibit objective structural or functional evidence of small or large fiber neuropathy compared to healthy controls.
Answers are grounded in this paper and cite their sources.
Symptoms of neuropathy common in POTS without objective confirmation; leaves open neuropathy mechanisms and GI links for further study.
AIM: 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. METHODS: 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 "High NSS" and "High IBS-SSS" if their total NSS vs. IBS-SSS were above median levels in POTS. RESULTS: 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 [1.62-3.08] vs. 1.63 [0.73-2.68] fibers/mm; p = 0.108). The patients with "high NSS" had slightly higher VPTs measured by MFV, although within normal ranges, compared to patients with "low NSS". The patients within the "high IBS-SSS" group had higher NSS (18.0 [14.3-22.8] vs. 11.0 [4.0-15.0]; p = 0.002) compared to patients with low total IBS-SSS. CONCLUSION: 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.
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Ekman et al. (2025) conducted a cross-sectional in Postural orthostatic tachycardia syndrome (POTS) (n=97). Postural orthostatic tachycardia syndrome (POTS) vs. Healthy controls was evaluated on Intraepidermal nerve fiber density (IENFD) (p=0.108). Postural orthostatic tachycardia syndrome was associated with severe peripheral sensory and gastrointestinal symptoms, but no significant differences in objective signs of neuropathy like intraepidermal nerve fiber density were found compared to healthy controls.
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