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July 19, 1985

Irritable Bowel, Mitral Valve Prolapse, and Associated Conditions

JAMA. 1985;254(3):359. doi:10.1001/jama.1985.03360030048012

To the Editor.—  In his Jan 4, 1985, letter, Sataline1 rightly calls attention to an association between the irritable bowel syndrome and the occurrence of mitral valve prolapse. We, too, have observed the association and believe that there is a spectrum of other, more complicated relationships that occur with this "syndrome." These included bowel and bladder dysfunction along with mitral valve prolapse and vascular headaches.Recently, one of us (P.G.C.) proposed a conceptual model that links bowel dysfunction, bladder dysfunction, and vascular headaches to hypokalemia, alkalosis, and abnormalities in the potassium-ammonia axis.2 Since this initial study, we have performed echocardiograms on 20 consecutive patients with the "bowel, bladder, headache syndrome." In each instance, varying degrees of mitral valve prolapse were observed. Furthermore, this constellation of findings is often associated with esophageal dysfunction. Hypomagnesemia is also a frequent concomitant.Many of the symptoms, including anxiety, panic attacks, fatigue, and