Autonomic Testing in Functional Gastrointestinal Disorders: Implications of Reproducible Gastrointestinal Complaints during Tilt Table Testing
Background: The pathophysiology of functional abdominal pain (FAP) is unknown. The upright portion of a tilt table test triggers typical symptoms in certain children. Aim: To compare the pathophysiology and treatment response of children with FAP whose gastrointestinal symptoms (GI) were replicate...
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| Format: | Article |
| Language: | English |
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Wiley
2009-01-01
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| Series: | Gastroenterology Research and Practice |
| Online Access: | http://dx.doi.org/10.1155/2009/868496 |
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| author | Shaista Safder Thomas C. Chelimsky Mary Ann O'Riordan Gisela Chelimsky |
| author_facet | Shaista Safder Thomas C. Chelimsky Mary Ann O'Riordan Gisela Chelimsky |
| author_sort | Shaista Safder |
| collection | DOAJ |
| description | Background: The pathophysiology of functional abdominal pain (FAP) is unknown. The upright portion of a tilt table test triggers typical symptoms in certain children.
Aim: To compare the pathophysiology and treatment response of children with FAP whose gastrointestinal symptoms (GI) were replicated (RGI) by tilt table testing (TTT) to those in whom TTT did not have this effect (NRGI).
Methods: An IRB-approved retrospective review of the autonomic laboratory database identified all children tested for GI complaints. We compared results of TTT, Valsalva maneuver, deep breathing and the axon reflex sweat test. Overall treatment response and that specific to fludrocortisone was ranked from 1 to 5, with 1 “much worse,” 3 “neutral,” and 5 “much better.”
Results: 32/76 identified children had reproducible symptoms on TTT (RGI) and 44 did not (NRGI). The RGI group was younger, had a shorter duration of symptoms, more postural tachycardia syndrome (POTS) and benefited more from fludrocortisone (73% in RGI vs. 25% in NRGI).
Conclusion: Dividing patients with FAP according to the effect of TTT on their symptoms appears to delineate 2 fundamentally different groups, with potentially different pathophysiologies and treatment responses. A prospective study is needed. |
| format | Article |
| id | doaj-art-c0ab98813fbc4046856b8ba575fa53c3 |
| institution | Kabale University |
| issn | 1687-6121 1687-630X |
| language | English |
| publishDate | 2009-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Gastroenterology Research and Practice |
| spelling | doaj-art-c0ab98813fbc4046856b8ba575fa53c32025-02-03T06:44:26ZengWileyGastroenterology Research and Practice1687-61211687-630X2009-01-01200910.1155/2009/868496868496Autonomic Testing in Functional Gastrointestinal Disorders: Implications of Reproducible Gastrointestinal Complaints during Tilt Table TestingShaista Safder0Thomas C. Chelimsky1Mary Ann O'Riordan2Gisela Chelimsky3Department of Pediatrics, Rainbow Babies and Children Hospital, Case medical Center, 11100 Euclid Avenue, Cleveland, Oh 44106, USADepartment of Neurology, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, 11100 Euclid Avenue, Cleveland, Oh 44106, USADepartment of Pediatrics, Rainbow Babies and Children Hospital, Case medical Center, 11100 Euclid Avenue, Cleveland, Oh 44106, USADepartment of Pediatrics, Rainbow Babies and Children Hospital, Case medical Center, 11100 Euclid Avenue, Cleveland, Oh 44106, USABackground: The pathophysiology of functional abdominal pain (FAP) is unknown. The upright portion of a tilt table test triggers typical symptoms in certain children. Aim: To compare the pathophysiology and treatment response of children with FAP whose gastrointestinal symptoms (GI) were replicated (RGI) by tilt table testing (TTT) to those in whom TTT did not have this effect (NRGI). Methods: An IRB-approved retrospective review of the autonomic laboratory database identified all children tested for GI complaints. We compared results of TTT, Valsalva maneuver, deep breathing and the axon reflex sweat test. Overall treatment response and that specific to fludrocortisone was ranked from 1 to 5, with 1 “much worse,” 3 “neutral,” and 5 “much better.” Results: 32/76 identified children had reproducible symptoms on TTT (RGI) and 44 did not (NRGI). The RGI group was younger, had a shorter duration of symptoms, more postural tachycardia syndrome (POTS) and benefited more from fludrocortisone (73% in RGI vs. 25% in NRGI). Conclusion: Dividing patients with FAP according to the effect of TTT on their symptoms appears to delineate 2 fundamentally different groups, with potentially different pathophysiologies and treatment responses. A prospective study is needed.http://dx.doi.org/10.1155/2009/868496 |
| spellingShingle | Shaista Safder Thomas C. Chelimsky Mary Ann O'Riordan Gisela Chelimsky Autonomic Testing in Functional Gastrointestinal Disorders: Implications of Reproducible Gastrointestinal Complaints during Tilt Table Testing Gastroenterology Research and Practice |
| title | Autonomic Testing in Functional Gastrointestinal Disorders: Implications of Reproducible Gastrointestinal Complaints during Tilt Table Testing |
| title_full | Autonomic Testing in Functional Gastrointestinal Disorders: Implications of Reproducible Gastrointestinal Complaints during Tilt Table Testing |
| title_fullStr | Autonomic Testing in Functional Gastrointestinal Disorders: Implications of Reproducible Gastrointestinal Complaints during Tilt Table Testing |
| title_full_unstemmed | Autonomic Testing in Functional Gastrointestinal Disorders: Implications of Reproducible Gastrointestinal Complaints during Tilt Table Testing |
| title_short | Autonomic Testing in Functional Gastrointestinal Disorders: Implications of Reproducible Gastrointestinal Complaints during Tilt Table Testing |
| title_sort | autonomic testing in functional gastrointestinal disorders implications of reproducible gastrointestinal complaints during tilt table testing |
| url | http://dx.doi.org/10.1155/2009/868496 |
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