E2 ModerateModerate confidencePEM not requiredCross-SectionalPeer-reviewedMachine draft
Functional gastrointestinal disorders are increased in joint hypermobility-related disorders with concomitant postural orthostatic tachycardia syndrome.
Tai, Foong Way David, Palsson, Olafur S, Lam, Ching Y et al. · Neurogastroenterology and motility · 2020 · DOI
Quick Summary
This study looked at people with joint hypermobility disorders (including Ehlers-Danlos syndrome) to understand how often they experience stomach and digestive problems. The researchers found that those who also have POTS (a condition affecting heart rate and blood pressure when standing) had significantly more digestive issues than those without POTS. The digestive problems remained worse in the POTS group even after accounting for other conditions like chronic fatigue syndrome.
Why It Matters
Many ME/CFS patients have comorbid connective tissue disorders and POTS, conditions that frequently cluster together. Understanding how POTS amplifies gastrointestinal symptom burden in hypermobility disorders may illuminate shared pathophysiological mechanisms relevant to ME/CFS populations and guide more targeted symptom management strategies.
Observed Findings
- 37.5% of HSD/hEDS survey participants reported a physician diagnosis of POTS
- POTS-positive subjects were significantly younger (37 vs 40 years, P=0.002) and more likely to report chronic fatigue syndrome (44% vs 31%, P<0.0001)
- POTS-positive individuals showed higher rates of Rome IV FGID criteria fulfillment across multiple organ domains
- Both upper and lower gastrointestinal symptoms were reported significantly more frequently in POTS-positive subjects
- Increased FGID associations persisted after adjustment for age, chronic fatigue syndrome, fibromyalgia, and depression scores
Inferred Conclusions
- POTS concomitance substantially amplifies functional gastrointestinal disorder burden in HSD/hEDS beyond what age, CFS, fibromyalgia, or mood disorders account for
- The relationship between POTS and GI symptom severity in hypermobility disorders is independent of commonly co-occurring systemic conditions
- Understanding the mechanisms by which POTS arises in and worsens GI outcomes in HSD/hEDS is essential for future therapeutic development
Remaining Questions
- What are the specific pathophysiological mechanisms linking POTS to increased GI dysfunction in hypermobility disorders?
- Does the autonomic dysfunction underlying POTS directly impair gastrointestinal motility, or are shared connective tissue abnormalities responsible?
What This Study Does Not Prove
This study demonstrates association but cannot establish causation—POTS may worsen GI symptoms, or both may share a common underlying pathology. Self-reported POTS diagnosis (not objectively measured via tilt testing) introduces potential misclassification bias. The findings are specific to HSD/hEDS populations and may not generalize to ME/CFS patients without hypermobility disorders.
Tags
Symptom:Orthostatic IntoleranceFatigue
Method Flag:PEM Not DefinedWeak Case DefinitionNo ControlsMixed Cohort
Metadata
- DOI
- 10.1111/nmo.13975
- PMID
- 32803794
- Review status
- Machine draft
- Evidence level
- Single-study or moderate support from human research
- Last updated
- 8 April 2026
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →
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