P0407 - Esophageal Symptoms in Postural Orthostatic Tachycardia Syndrome: A Retrospective Analysis of Esophageal Manometry Data From an Academic Medical Center

Sunday, October 22, 2023

3:30 PM – 7:00 PM PT

Location: Exhibit Hall

Presenting Author(s)

AP

Archna Patel, MD, MPH (she/her/hers)

Mayo Clinic
Scottsdale, AZ

Archna Patel, MD, MPH¹, Michael D. Crowell, PhD¹, Brent Goodman, MD², Jennifer L. Horsley-Silva, MD³, Laura Budvytyte, ², Marcelo F. Vela, MSCR¹, Karissa Arca, MD⁴, Lucinda A. Harris, MD¹
¹Mayo Clinic, Scottsdale, AZ; ²Mayo Clinic, Phoenix, AZ; ³Mayo Clinic Arizona, Phoenix, AZ; ⁴Mayo Clinic Arizona, Scottsdale, AZ

Introduction: Postural orthostatic tachycardia syndrome (POTS) is associated with gastrointestinal (GI) and esophageal dysmotility. Our group has previously reported on abnormalities seen on high-resolution esophageal manometry (HREM) in this population. Herein, we aim to identify significant trends in esophageal manometry findings in patients with a diagnosis of POTS vs. controls who have undergone HREM.

Methods: Retrospective data analysis of patients aged 18 or older diagnosed with POTS who underwent outpatient esophageal manometries between March 2012 – November 2022. Patients with prior esophageal surgery or active opioid use were excluded from the study. Control subjects met the same exclusion criteria and were selected in a consecutive case-controlled fashion. The Chicago Classification v3.0 and v4.0 were used to categorize esophageal motility disorders based on HREM. Statistical significance was calculated using Fisher’s Exact Test for Count Data.

Results: Ninety-two of the 124 (74.2%) patients with POTS who underwent esophageal manometry met inclusion criteria. Dysphagia was the most common indication for HREM testing among POTS patients. Presence of hypotensive lower esophageal sphincter (LES) pressure (29.3%) was more common in POTS patients compared to controls (12.3%, p = 0.011). POTS patients had increased prevalence of ineffective esophageal motility or weak peristalsis (28.3%) vs. controls (16.3%, p = 0.076), reaching near significance. Controls had a higher prevalence of achalasia (9.78% vs. 1.1% in POTS patients, p = 0.018) and EGJ pressure separation (38.0% vs. 6.52% in POTS patients, p < 0.0001). The control group neared significance on distal esophageal spasm (DES, 7.61% vs. 1.1% in POTS patients, p = 0.064).

Discussion: This study corroborates a higher prevalence of hypotensive LES in patients with POTS, which was also reported in our previous study.³We also found weaker peristalsis in these patients. In conjunction, this likely reflects autonomic dysfunction and signals these patients are at higher risk of ineffective motility. The higher prevalence of EGD pressure separation and achalasia in controls can likely be attributed to age, as POTS tends to occur in young females.⁴These results provide objective evidence of esophageal dysfunction in POTS patients and underscore the importance of using HREM to evaluate GI symptoms and provide effective treatment and symptom management.

	POTS (n = 92)		Control group (n = 92)		POTS	Control	p-value*
	Abnormal	Normal	Abnormal	Normal	% Abnormal	% Abnormal
Findings	42	50	43	49	45.6522%	0%	1
Achalasia	1	91	9	83	1.087%	9.78%	0.0182
Esophagogastric outflow obstruction	6	86	13	79	6.52%	14.13%	0.1445
Distal esophageal spasm (DES)	1	91	7	85	1.09%	7.61%	0.0644
Hypercontractile or Jackhammer esophagus	0	92	3	89	0%	3.26%	0.2459
Absent contractility	3	89	2	90	3.26%	2.17%	1
Fragmented peristalsis	1	91	2	90	1.09%	2.17%	1
Ineffective esophageal motility (IEM, weak peristalsis)	26	66	15	77	28.26%	16.30%	0.0757
Hypertensive lower esophageal sphincter (EGJ) pressure	6	86	6	86	6.52%	6.52%	1
Hypotensive lower esophageal sphincter (EGJ) pressure	27	65	12	80	29.35%	13.04%	0.0109
Scleroderma esophagus	0	92	3	89	0%	3.26%	0.2459
Nonspecific abnormalities	11	81	5	87	11.96%	5.43%	0.1896
EGJ Pressure Separation (Hiatal hernia)	6	86	35	57	6.52%	38.04%	< 0.00001

Table: Chicago Classification by High Resolution Esophageal Manometry (HREM) in a group with a diagnosis of postural orthostatic tachycardia syndrome (POTS) versus a control group without a diagnosis of POTS.

*statistically significant p<0.05

Disclosures:

Archna Patel indicated no relevant financial relationships.

Michael Crowell indicated no relevant financial relationships.

Brent Goodman indicated no relevant financial relationships.

Jennifer Horsley-Silva: Regeneron – Advisory Committee/Board Member, Independent Contractor. Sanofi – Advisory Committee/Board Member.

Laura Budvytyte indicated no relevant financial relationships.

Marcelo Vela: Medtronic – Consultant.

Karissa Arca indicated no relevant financial relationships.

Lucinda Harris: AbbVie – Consultant. Ardelyx – Consultant. Gemelli Biotech – Advisor or Review Panel Member. Mahana – Consultant. QOL – Consultant. Salix – Consultant. takeda – Grant/Research Support.

Archna Patel, MD, MPH¹, Michael D. Crowell, PhD¹, Brent Goodman, MD², Jennifer L. Horsley-Silva, MD³, Laura Budvytyte, ², Marcelo F. Vela, MSCR¹, Karissa Arca, MD⁴, Lucinda A. Harris, MD¹. P0407 - Esophageal Symptoms in Postural Orthostatic Tachycardia Syndrome: A Retrospective Analysis of Esophageal Manometry Data From an Academic Medical Center, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.