Related Experiment Video
Updated: Mar 26, 2026
Fabrication and Implantation of Miniature Dual-element Strain Gages for Measuring In Vivo Gastrointestinal Contractions in Rodents.
Published on: September 18, 2014
Antroduodenal Manometry Is Abnormal in Children Presenting With Orthostatic Intolerance and Gastrointestinal Symptoms
Jeffrey P Moak1, Robin R Fabian, Lindsay C Clarke
1*Division of Cardiology †Division of Gastroenterology, Children's National Medical Center, Washington, DC.
Insights
Gastrointestinal symptoms are common in patients with orthostatic intolerance (OI). Antroduodenal manometry (ADM) revealed frequent upper GI dysmotility in children with OI and GI issues, suggesting ADM is crucial for evaluation.
Area of Science:
- Pediatric Gastroenterology
- Autonomic Nervous System Disorders
- Clinical Physiology
Background:
- Gastrointestinal (GI) symptoms like nausea and abdominal pain are prevalent in patients with orthostatic intolerance (OI), encompassing neurally mediated hypotension (NMH) and postural orthostatic tachycardia syndrome (POTS).
- Autonomic dysregulation is the established cause of cardiovascular symptoms in POTS, and the autonomic nervous system's role in GI motility suggests a link between POTS and GI dysfunction.
Purpose of the Study:
- To investigate the hypothesis that patients with POTS and concurrent GI symptoms exhibit upper GI tract autonomic dysmotility.
- To assess the utility of antroduodenal manometry (ADM) in evaluating GI motility in pediatric patients with OI and GI symptoms.
Main Methods:
- Thirty-five pediatric subjects diagnosed with OI and experiencing GI symptoms underwent 24-hour antroduodenal manometry (ADM).
- Autonomic function was assessed using tilt table testing (TTT) and pharmacologic challenges.
- Data analysis focused on comparing baseline ADM results with those obtained during TTT and pharmacologic challenge.
Main Results:
- All 35 subjects exhibited abnormal TTT results, with 62% showing abnormal Valsalva testing and 54% having a corrected QT interval ≥0.44 seconds.
- GI symptoms were reproduced in 89% of subjects during TTT.
- Baseline ADM was abnormal in 14% of subjects, increasing to 68% during TTT, with overall abnormal ADM in 74% of patients.
Conclusions:
- Antroduodenal manometry (ADM) frequently identifies upper GI dysmotility in children with orthostatic intolerance (OI) and associated GI symptoms.
- Upper GI motility studies, such as ADM, are recommended as a key component in the comprehensive diagnostic evaluation of pediatric patients presenting with OI and GI complaints.
Objectives:
Gastrointestinal (GI) symptoms of nausea, vomiting, and abdominal pain are common in patients with orthostatic intolerance (OI), including neurally mediated hypotension (NMH) and postural orthostatic tachycardia syndrome (POTS). Autonomic dysregulation is considered the underlying pathophysiology behind the cardiovascular symptoms of POTS. Because the autonomic nervous system also regulates GI motility, we hypothesized that patients with POTS and GI symptoms will have evidence of autonomic dysmotility of the upper GI tract.
Methods:
Thirty-five subjects with OI and GI symptoms were studied. All the subjects had a 24-hour antroduodenal manometry (ADM) study, in conjunction with pharmacologic challenge and autonomic and tilt table testing (TTT).
Results:
The mean subject age was 16.2 ± 2.8 years (range 10-23.8 years), and male to female ratio was 10:25. TTT was abnormal in all the 35 subjects, whereas Valsalva testing was abnormal (+40 mmHG) in 21 of 34 (62%) subjects, and corrected QT interval was ≥0.44 seconds in 19 of 35 (54%) subjects. During TTT, GI symptoms were reproduced in 31 of 35 (89%) studies. ADM was found to be abnormal at baseline, before the TTT in 5 of 35 (14%) subjects, whereas it became abnormal in 23 of 34 (68%) subjects during TTT. In addition, the expected response to the pharmacologic challenge was limited. Overall, ADM was abnormal in 26 of 35 (74%) patients either at baseline or during TTT in these subjects with OI.
Conclusions:
ADM is frequently abnormal in children with OI and GI symptoms. Upper GI motility studies should be a part of the comprehensive evaluation in this population.
Related Concept Videos
01:26Imaging Studies III: Gastrointestinal Motility Studies and Virtual Colonoscopy
Radionuclide Testing
Radionuclide testing is a sophisticated medical technique for assessing gastrointestinal motility. It focuses on gastric emptying and colonic transit time. Radioactive markers track the movement of food through the digestive system, providing insights into gastrointestinal disorders.
In gastric emptying studies, a meal's liquid and...
01:20Gastrointestinal Motility Disorders
01:29Endoscopic Procedures I: Esophagogastroduodenoscopy
During an EGD, the endoscope can be used to:
01:28Drugs Affecting GI Tract Motility: Dopamine Receptor Antagonists
01:17Assessment of the Gastrointestinal System I: Subjective Data
Health History
The initial step in assessing the GI system is obtaining a comprehensive health history. This includes inquiring about the patient's history or presence of problems...
01:29Gastroesophageal Reflux Disease II: Clinical Features and Management
Clinical Manifestations
GERD presents itself in a multitude of ways, with symptoms varying from person to person. The hallmark symptoms are...