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

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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

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Episode Transcript

Speaker 1 (00:00):
Life moves fast and so should the answers to your
biggest questions.
Welcome to EndoBattery's QuickConnect, your direct line to
expert insights Short, powerfuland right to the point.
You send in the questions, Ibring in the experts and in just
five minutes you get theknowledge you need.
No long episodes, no extra timeneeded, and just remember

(00:20):
expert opinions shared here arefor general information and not
for personalized medical advice.
Always consult your providerfor your case-specific guidance.
Got a question?
Send it in and let's quicklyget you the answers.
I'm your host, alana, and it'stime to connect.
I'm joined by my guest, drZachary Spiritsos, a

(00:44):
board-certifiedneurogastroenterologist with a
passion for treating irritablebowel syndrome, functional
abdominal pain and mobilitydisorders.
With a strong background inteaching, research and
patient-centered care, he bringsa wealth of knowledge and
compassion to the table.
Please help me in welcoming DrZach Spiritos.
Dr Zach Spiritos, talk to us alittle bit about what you see in

(01:10):
symptoms with your hypermobileEDS people and your POTS people
and the MCAS people.
What are the things that yousee most in those patients?
Because I bet you, if we couldsit down and identify, okay,
these are some of our symptomstoo.
Here's maybe some ways we canaddress that.
What do you typically see inthose three subsets of patients?

Speaker 2 (01:30):
Yeah, so they land in my lap.
So I'm aneurogastroenterologist, so I
stole this from this amazinglysmart doctor, dr Brandler, who's
a neurogastroenterologist up inSeattle, and it's we are
electricians, not plumbers, okay.
And so when patients come to methey have GI symptoms, but then
they start talking about otherthings that don't necessarily

(01:53):
fit into IBS.
So I initially, when I firstgraduated and I was in practice,
I took on a lot of IBS patients.
I just happened to love takingcare of that patient population.
But then someone would say youdon't have IBS.
But all of a sudden when I getup, my heart just races, like
that's not IBS.
I think an antiquated view ofthat is like, oh, you're
stressed and stress causesanxiety and stress causes

(02:14):
palpitations.
But this is different.
So in POTS the hallmark featureis standing up and just feeling
like your heart is racing.
Okay, and with that I would saythat brain fog is a really big
symptom there.
And then, kind of secondarily,some people get a lot of blood

(02:39):
pooling in their feet, liketheir feet get swollen.
But yeah, certainly thestanding tachycardia or the
heart racing from going orsitting to a standing position
is the hallmark features ofpostural orthostatic tachycardia
syndrome, but they also mayhave a lot of GI symptoms
getting full early, tons ofbloating, loose stools,
conversely constipation.
So the POTS GI system doesn'treally follow any specific

(03:02):
rulebook, unfortunately.
Yeah, okay, so mass cellactivation syndrome is and of
course this can be linked withPOTS too.
So when I'm talking to one ofthese patients I'm asking all
these questions, I'm screeningfor every one of these things to
see if we can kind of piecethis together.
But the hallmark feature ofmass cell activation syndrome is

(03:23):
probably skin manifestations,so itching, rashes, secondarily
kind of ears, nose and throatissues, rhinorrhea, eyes
watering for, like, no goodreason.
And then GI symptoms are kindof probably coming third there
and that's bloating, diarrhea,diarrhea, lots of heartburn and

(03:45):
someone who, like shouldn't getheart.
You know heartburntraditionally affects people who
are, you know, a little bitolder, you know have their bmis,
or are you probably closer to30, like we see these young
women who are 22, 23, withrip-roaring heartburn.
I'm like that ain't cured, itjust doesn't make any sense and
that's m.
So that's where.

(04:06):
So, just like one of the,without getting too into the
nitty gritty of thepathophysiology of MCAS, but
these mast cells are just verytwitchy right.
They're intended to beselectively defensive against
certain pathogens that our bodydoesn't like.
Like you know, mold Ifanybody's in North Carolina like
me just the pollen is insane.

(04:27):
So mast cells are supposed tobe acting up now, but these mast
cells become twitchy and reactto virtually everything, from
temperature changes to emotionalchanges, to poor sleep, to
medications.
It's really wild, and one ofthe chemicals that it releases
and it releases hundreds ofchemicals is histamine, and
histamine plays a big role increating acid secretion from the

(04:49):
stomach which could lead toheartburn symptoms.
But for all intents and purposes, patients don't behave like
traditional gastroesophagealreflux patients.
They don't respond to protonpump inhibitors and they have no
darn reason to have reflux tobegin with.
They don't have a big hiatalhernia, which is a traditional
risk factor for heart reflux, orthey're not.
You know they're not.
They're not overweight, and sothat's where you have to start.

(05:11):
You know this doesn't quitemake sense, okay, and you said
EDS.

Speaker 1 (05:17):
EDS, this is a big one for us, okay, I?

Speaker 2 (05:19):
have a lot of questions for this one.
So again I have a lot ofquestions for this one.
So again, I'm a GI doctor so Ideal with a lot of the GI
manifestations.
But I certainly screen for allof you know, all my patients who
I you know, who have MCAS, whohave POTS, for EDS, specific
symptoms and the Baten score isreally nice Testing certain
joint mobile hyperflexibility.
You know, being able to putboth palms on the floor with

(05:42):
extended knees.
You know, are you able to bendyour pinky back beyond a certain
angle?
You'd be able to bend yourthumb beyond a certain angle and
you can look up the bite andscore and kind of assess for
yourself.
But you know, did you have kindof weird random joint
subluxations as a kid?
Did your knee just pop out ofjoint, like that's not supposed
to happen, right, and they'relike oh yeah, we put a brace on
it and kind of said that wasfine.
I was like that's not fine,like that doesn't happen.

(06:04):
So you have to always ask why,exactly like if you're an
exchange, like if you're seanwhite and doing, you know, kick
flips on the, uh, on the, on thehalf pipe, fine, like that's,
that's reasonable.
But just like, yeah, I wasplaying kickball and my knee
just popped out of place, likethat's not a thing, right?
So in a, in a nutshell, like avery condensed, oversimplified
way of kind of, I think,compartmentalizing those

(06:26):
conditions.
So it's really important, youknow, to really do a thorough
review of systems and ask allthe questions so you can really
understand why somethinghappened.

Speaker 1 (06:36):
That's a wrap for this Quick Connect.
I hope today's insights helpedyou move forward with more
clarity and confidence.
Do you have more questions?
Keep them coming, send them inand I'll bring you the expert
answers.
You can send them in by usingthe link in the top of the
description of this podcastepisode or by emailing contact
at endobatterycom or visitingthe endobatterycom contact page.

(07:01):
Until next time, keep feelingempowered through knowledge.