QC: Connecting the Dots: GI Symptoms in POTS, MCAS, and EDS Patients With Dr. Zac Spiritos

Dr. Zachary Spiritsos shares expert insights on the connections between digestive issues and conditions like POTS, MCAS, and EDS. He explains how these overlapping conditions present with distinct symptom patterns that can help patients better understand their complex health challenges.

• Neurogastroenterologists are "electricians, not plumbers" - focusing on nervous system connections to digestive issues
• POTS typically presents with racing heart upon standing, brain fog, blood pooling, and various GI symptoms
• MCAS features "twitchy" mast cells that react to everything from temperature changes to emotions
• Primary MCAS symptoms include skin manifestations (itching, rashes), ENT issues, and GI symptoms like unexplained heartburn
• EDS often shows up through joint hypermobility, subluxations, and can be assessed using the Beighton score
• These conditions frequently overlap, requiring thorough questioning to properly identify and treat

Send in your questions by using the link in the top of the description of this podcast episode, emailing contact@endobattery.com, or visiting the endobattery.com contact page.

Chapters

• 0:00 Introduction to Quick Connect
• 0:37 Dr. Spiritsos: Neurogastroenterology Expert
• 1:30 POTS Symptoms and GI Connections
• 3:11 MCAS: Beyond Skin Manifestations
• 5:19 EDS Symptoms and Joint Mobility
• 6:36 Episode Closing and Contact Information

Transcript

Speaker 1: 0:00

Life moves fast and so should the answers to your biggest questions. Welcome to EndoBattery's Quick Connect, your direct line to expert insights Short, powerful and right to the point. You send in the questions, I bring in the experts and in just five minutes you get the knowledge you need. No long episodes, no extra time needed, and just remember expert opinions shared here are for general information and not for personalized medical advice. Always consult your provider for your case-specific guidance. Got a question? Send it in and let's quickly get you the answers.

Speaker 1: 0:34

I'm your host, alana, and it's time to connect. I'm joined by my guest, dr Zachary Spiritsos, a board-certified neurogastroenterologist with a passion for treating irritable bowel syndrome, functional abdominal pain and mobility disorders. With a strong background in teaching, research and patient-centered care, he brings a wealth of knowledge and compassion to the table. Please help me in welcoming Dr Zach Spiritos. Dr Zach Spiritos, talk to us a little bit about what you see in symptoms with your hypermobile EDS people and your POTS people and the MCAS people. What are the things that you see most in those patients? Because I bet you, if we could sit down and identify, okay, these are some of our symptoms too. Here's maybe some ways we can address that. What do you typically see in those three subsets of patients?

Speaker 2: 1:30

Yeah, so they land in my lap. So I'm a neurogastroenterologist, so I stole this from this amazingly smart doctor, dr Brandler, who's a neurogastroenterologist up in Seattle, and it's we are electricians, not plumbers, okay. And so when patients come to me they have GI symptoms, but then they start talking about other things that don't necessarily fit into IBS. So I initially, when I first graduated and I was in practice, I took on a lot of IBS patients. I just happened to love taking care of that patient population. But then someone would say you don't have IBS. But all of a sudden when I get up, my heart just races, like that's not IBS. I think an antiquated view of that is like, oh, you're stressed and stress causes anxiety and stress causes palpitations. But this is different. So in POTS the hallmark feature is standing up and just feeling like your heart is racing. Okay, and with that I would say that brain fog is a really big symptom there. And then, kind of secondarily, some people get a lot of blood pooling in their feet, like their feet get swollen. But yeah, certainly the standing tachycardia or the heart racing from going or sitting to a standing position is the hallmark features of postural orthostatic tachycardia syndrome, but they also may have a lot of GI symptoms getting full early, tons of bloating, loose stools, conversely constipation. So the POTS GI system doesn't really follow any specific rulebook, unfortunately.

Speaker 2: 3:03

Yeah, okay, so mass cell activation syndrome is and of course this can be linked with POTS too. So when I'm talking to one of these patients I'm asking all these questions, I'm screening for every one of these things to see if we can kind of piece this together. But the hallmark feature of mass cell activation syndrome is probably skin manifestations, so itching, rashes, secondarily kind of ears, nose and throat issues, rhinorrhea, eyes watering for, like, no good reason. And then GI symptoms are kind of probably coming third there and that's bloating, diarrhea, diarrhea, lots of heartburn and someone who, like shouldn't get heart. You know heartburn traditionally affects people who are, you know, a little bit older, you know have their bmis, or are you probably closer to 30, like we see these young women who are 22, 23, with rip-roaring heartburn. I'm like that ain't cured, it just doesn't make any sense and that's m. So that's where.

Speaker 2: 4:06

So, just like one of the, without getting too into the nitty gritty of the pathophysiology of MCAS, but these mast cells are just very twitchy right. They're intended to be selectively defensive against certain pathogens that our body doesn't like. Like you know, mold If anybody's in North Carolina like me just the pollen is insane. So mast cells are supposed to be acting up now, but these mast cells become twitchy and react to virtually everything, from temperature changes to emotional changes, to poor sleep, to medications. It's really wild, and one of the chemicals that it releases and it releases hundreds of chemicals is histamine, and histamine plays a big role in creating acid secretion from the stomach which could lead to heartburn symptoms.

Speaker 2: 4:51

But for all intents and purposes, patients don't behave like traditional gastroesophageal reflux patients. They don't respond to proton pump inhibitors and they have no darn reason to have reflux to begin with. They don't have a big hiatal hernia, which is a traditional risk factor for heart reflux, or they're not. You know they're not. They're not overweight, and so that's where you have to start. You know this doesn't quite make sense, okay, and you said EDS.

Speaker 1: 5:17

EDS, this is a big one for us, okay, I?

Speaker 2: 5:19

have a lot of questions for this one.

Speaker 2: 5:21

So again I have a lot of questions for this one. So again, I'm a GI doctor so I deal with a lot of the GI manifestations. But I certainly screen for all of you know, all my patients who I you know, who have MCAS, who have POTS, for EDS, specific symptoms and the Baten score is really nice Testing certain joint mobile hyperflexibility. You know, being able to put both palms on the floor with extended knees. You know, are you able to bend your pinky back beyond a certain angle? You'd be able to bend your thumb beyond a certain angle and you can look up the bite and score and kind of assess for yourself.

Speaker 2: 5:51

But you know, did you have kind of weird random joint subluxations as a kid? Did your knee just pop out of joint, like that's not supposed to happen, right, and they're like oh yeah, we put a brace on it and kind of said that was fine. I was like that's not fine, like that doesn't happen. So you have to always ask why, exactly like if you're an exchange, like if you're sean white and doing, you know, kick flips on the, uh, on the, on the half pipe, fine, like that's, that's reasonable. But just like, yeah, I was playing kickball and my knee just popped out of place, like that's not a thing, right? So in a, in a nutshell, like a very condensed, oversimplified way of kind of, I think, compartmentalizing those conditions. So it's really important, you know, to really do a thorough review of systems and ask all the questions so you can really understand why something happened.

Speaker 1: 6:36

That's a wrap for this Quick Connect. I hope today's insights helped you move forward with more clarity and confidence. Do you have more questions? Keep them coming, send them in and I'll bring you the expert answers. You can send them in by using the link in the top of the description of this podcast episode or by emailing contact at endobatterycom or visiting the endobatterycom contact page. Until next time, keep feeling empowered through knowledge.