Background
Women with chronic pelvic pain (CPP) have poor cardiovagal modulation. It is unclear whether this finding reflects a broader abnormality across many systems such as gastro‐vagal ...modulation.
Aim
To determine if maladaptive cardiovagal activity in females with CPP is accompanied by maladaptive gastric myoelectric activity.
Methods
A total of 36 health controls (HC) and 75 CPP underwent supine (10 min), then upright (tilted 70° head up; 30 min), and back to supine (10 min) positions. High‐frequency heart rate variability (HF‐HRV; 0.15‐0.4 Hz) was measured as an index of cardiovagal activity. Cutaneous electrogastrography (EGG) assessed gastric myoelectric activity pre‐ and during‐upright tilt. EGG measures from 16 HC and 31 CPP patients were available for analysis and included relative percentage of gastric activity within the normal (2‐4 cpm) and tachygastria (4–10 cpm) ranges, plus ratio of normal/tachygastria.
Results
HF‐HRV was lower in CPP individuals at all time points (each p < .05). CPP individuals showed lesser decrease in HF‐HRV from supine to upright, and poorer HF‐HRV recovery from upright back to supine (F1, 106 = 4.62, p = .034). HC showed increase in tachygastria activity (t15 = −2.09, p = .054) while the CPP group showed no change in tachygastria activity from pre‐upright to upright (t30 = −0.62, p = .537).
Conclusions
Individuals with CPP going from supine to upright demonstrate an impairment in both tachygastria and the parallel decrement in HRV. These results support the hypothesis of a generalized blunting in the physiological modulation in CPP individuals affecting both cardiovascular and gastric systems.
Background and Objectives
Though reduced cardiovagal modulation accompanies adult IBS, adolescents with functional gastrointestinal disorders (FGID) have not been studied. We aim to investigate ...whether adolescents with FGID have reduced cardiovagal modulation.
Methods
After 10‐minute supine rest, we recorded ECG for 5‐minute supine and 5‐minute standing without support in healthy and FGID‐affected adolescents. After analysis with Kubios 2.2 for high‐frequency (hf) and low‐frequency (lf) heart rate variability (HRV), Wilcoxon signed‐ranks test compared individual paired supine and standing HRV data, while Kruskal‐Wallis and Mann‐Whitney U tests compared HRV across groups.
Results
A total of 50 FGID subjects (90% females; median age 17 years range 11‐21) and 22 healthy comparison group (HC) (59% females; median age 14 years range 10‐18) participated. Both absolute and relative supine hfHRV exceeded standing in both groups. Absolute supine lfHRV was higher than standing in FGID patients and not in HCs, while relative supine lfHRV power was actually lower in both groups. Compared to HC, FGID group showed significantly lower absolute HRV, while relative HRV did not differ between groups.
Conclusions
Cardiovagal modulation is lower in adolescents with FGID. This difference impacts these subjects significantly. Whether this finding reflects a cause or a consequence of FGID is unknown.
Cardiovagal modulation measured through heart rate variability is lower in adolescents with FGID. This difference impacts these subjects significantly.
Functional gastrointestinal disorders (FGIDs) are common. The poor health-related quality of life in FGIDs is a combination of gastrointestinal symptoms and comorbid conditions. We determined by ...using the Ohio Dysautonomia questionnaire the medical comorbidities in 38 children with FGID. Almost all of the subjects had a comorbid disorder, with orthostatic symptoms in 89%, fainted >3×/lifetime in 17%, headaches with migrainous features in 40%, other types of chronic pain in 50%, and fatigue lasting >6 months in approximately 33%. These findings constitute a critical first step in changing the paradigm of our approach to FGID as a broader systemic disorder, not one limited to the gastrointestinal tract.
Postural tachycardia syndrome (POTS) is a fairly common condition that may or may not be associated with autonomic neuropathy. In a retrospective analysis, we compared two groups of patients based on ...clinical and autonomic criteria, those with POTS in isolation (POTS-Alone), and POTS with evidence of autonomic neuropathy (POTS-AN). Of 260 records reviewed, 57 patients met the criteria for POTS; 38 (67%) patients assigned to the POTS-Alone group and 19 (33%) patients assigned to the POTS-AN group. A decreased sweat output on the quantitative sudomotor axon reflex test is the most frequent abnormal finding in the POST-AN group suggesting sympathetic cholinergic neuropathy. Clinically, headache and gastrointestinal symptoms were more frequent among the POTS-AN group. Therefore, POTS may exist in isolation and may differ from those associated with AN.
Purpose We determined whether abnormal autonomic nervous system innervation of the bladder underlies IC (interstitial cystitis)/BPS (bladder pain syndrome) differently than other chronic pelvic pain. ...Materials and Methods In this institutional review board approved protocol 39 healthy controls and 134 subjects were enrolled, including 36 with IC/BPS, 14 with myofascial pelvic pain and 42 with IC/BPS plus myofascial pelvic pain. Three subjects were excluded from study. Autonomic nervous system evaluations included deep breathing, the Valsalva maneuver, and the tilt table and sudomotor tests. The latter evaluates autonomic neuropathy. A modified validated composite autonomic laboratory score was applied. Results Median age in the IC/BPS group was 47.5 years (range 21 to 78), greater than in healthy controls (34 years, range 20 to 75, p = 0.006), the myofascial pelvic pain group (33 years, range 22 to 56, p = 0.004) and the IC/BPS plus myofascial pelvic pain group (38 years, range 18 to 64, p = 0.03). Body mass index did not significantly differ but the myofascial pelvic pain and IC/BPS plus myofascial pelvic pain groups had a higher body mass index than healthy controls (p = 0.03 and 0.05, respectively). Cardiovascular and adrenergic indexes did not differ. The tilt table test showed more orthostatic intolerance in all chronic pelvic pain groups. Tilt table test diagnoses (orthostatic hypotension, postural tachycardia syndrome and reflex syncope) were rare. Baseline heart rate was higher in all chronic pelvic pain groups (p = 0.004). Compared to healthy controls all myofascial pelvic pain groups showed significantly more clear-cut autonomic neuropathy, defined as a sweat score of 3 or greater (vs IC/BPS plus myofascial pelvic pain p = 0.007 and vs myofascial pelvic pain p = 0.03). Conclusions Some chronic pelvic pain types show autonomic neuropathy and some show vagal withdrawal. In all types orthostatic intolerance likely reflects central sensitization and perhaps catastrophizing. Some of these findings suggest novel therapeutic targets.
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