Objectively diagnosing rumination syndrome in children using esophageal <scp>pH</scp>‐impedance and manometry

Singendonk, Maartje; Oors, Jac; Bredenoord, Albert J.; Omari, Taher; Pol, Rachel J. van der; Smits, Marije J.; Benninga, Marc A.; Wijk, Michiel P. van

doi:10.1111/nmo.12996

Cited by 23 publications

(22 citation statements)

References 32 publications

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“…Utilizing antroduodenal motility studies or high-resolution esophageal manometry (HREM) with esophageal impedance monitoring, the physiologic changes occurring during a rumination episode have been well-described and appear consistent irrespective of the triggering event. Although the intragastric pressure threshold has varied somewhat from study to study, rumination involves strong voluntary but generally unconscious contraction of the muscles of the abdominal wall promoting an increase in intragastric pressure with subsequent movement of gastric contents into the esophagus and mouth (i.e., the "R" or retrograde wave) (30,31). Care needs to be taken to ensure that increases in abdominal pressure are not due to coughing or speaking.…”

Section: Pathophysiologymentioning

confidence: 99%

Rumination Syndrome in Children and Adolescents: A Mini Review

et al. 2021

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Introduction: Rumination syndrome involves recurrent regurgitation of food and is believed to be underdiagnosed with patients experiencing long delays in diagnosis. It can be associated with significant social consequences, high rates of school absenteeism, and medical complications such as weight loss. The primary aims of the current review are to assess the literature regarding prevalence, pathophysiology, and treatment outcomes with a focus on neurotypical children and adolescents.Results: Population studies in children/adolescents, 5 years of age or older, range from 0 to 5.1%. There are fewer studies in clinical settings, but the prevalence appears to be higher in patients with other gastrointestinal symptoms, particularly chronic vomiting. While physiologic changes that occur during a rumination episode are well-described, the underlying cause is less well-defined. In general, rumination appears to have similarities to other functional gastrointestinal disorders including dysmotility, possibly inflammation, and an interaction with psychologic function. While diaphragmatic breathing is considered the mainstay of treatment, pediatric data demonstrating efficacy is lacking, especially as an isolated treatment.Conclusion: Pediatric rumination syndrome remains greatly understudied, particularly regarding treatment. There is a need to better define prevalence in both the primary care and subspecialty clinical settings, especially in patients presenting with vomiting or apparent gastroesophageal reflux. There is a need to determine whether treatment of co-morbid conditions results in improvement of rumination. Diaphragmatic breathing needs to be studied and compared to other competing responses.

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Section: Pathophysiologymentioning

confidence: 99%

Rumination Syndrome in Children and Adolescents: A Mini Review

et al. 2021

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“…Comorbidities may explain variation in pathophysiology that contributes to RS maintenance. Rumination syndrome can be comorbid with other reflux- and vomiting-based conditions, such as gastroparesis (42), gastroesophageal reflux disease (43), and self-induced vomiting (40). Preliminary studies suggest that some individuals display 3 primary pathophysiological RS variants: primary, secondary, and supragastric rumination (36,44).…”

Section: Clinical Featuresmentioning

confidence: 99%

“…For example, some patients may describe sensation of food sticking in the esophagus; this could represent heightened attention to changes in visceral sensations associated with RS (e.g., the premonitory urge before regurgitation) or could represent structural causes (e.g., esophageal dysphagia). Future research is needed to examine the sensitivity, specificity, and incremental utility of high-resolution esophageal manometry with impedance, which recent research suggests can detect RS if postprandial gastric pressure exceeds 25–30 mm Hg (32,43,44).…”

Section: Strategies For Effective Assessmentmentioning

confidence: 99%

Diagnosis and Treatment of Rumination Syndrome: A Critical Review

et al. 2019

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Rumination syndrome (RS) is characterized by the repeated regurgitation of material during or soon after eating with the subsequent rechewing, reswallowing, or spitting out of the regurgitated material. Rumination syndrome is classified as both a “Functional Gastroduodenal Disorder” (by the Rome Foundation’s Functional Gastrointestinal Disorders: Disorders of Gut-Brain Interaction, 4th edition) and a “Feeding and Eating Disorder” (by the Diagnostic and Statistical Manual of Mental Disorders, 5th edition). Rumination syndrome is a disorder that is often inaccurately diagnosed or missed, resulting in patients experiencing protracted symptoms and not receiving treatment for long periods. There is a lack of clear consensus for RS diagnosis, mechanisms that maintain RS, and treatment. Guided by existing research and our clinical expertise, we synthesize available evidence and provide recommendations for clinical use. We present a case example and critically summarize the literature to date to (i) increase clinicians’ understanding of heterogeneous clinical presentations, (ii) suggest assessment strategies to facilitate accurate diagnosis, and (iii) provide a schematic for intervention options. Overall, we recommend clinicians recognize the heterogeneous features of RS when considering diagnosis, assess for RS symptoms by clinical history, and treat RS with targeted diaphragmatic breathing while using other methods as augmented intervention or alternative treatment.

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“…The authors therefore felt encouraged combined 24‐hour pH‐impedance monitoring and manometry could be applied to diagnose rumination syndrome among children. Furthermore, they proposed a cutoff for gastric pressure increase >25 mm Hg with concomitant retrograde bolus flow into the proximal esophagus as diagnostic for the syndrome 50 …”

Section: Rumination Syndromementioning

confidence: 99%

The role of ambulatory 24‐hour esophageal manometry in clinical practice

Kamal

Clarke

Oors³

et al. 2020

Neurogastroenterology Motil

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High‐resolution manometry revolutionized the assessment of esophageal motility disorders and upgraded the classification through the Chicago Classification. A known disadvantage of standard HRM, however, is the inability to record esophageal motility function for an extended time interval; therefore, it represents only a more snapshot view of esophageal motor function. In contrast, ambulatory esophageal manometry measures esophageal motility over a prolonged period and detects motor activity during the entire circadian cycle. Furthermore, ambulatory manometry has the ability to measure temporal correlations between symptoms and motor events. This article aimed to review the clinical implications of ambulatory esophageal manometry for various symptoms, covering literature on the manometry catheter, interpretation of findings, and relevance in clinical practice specific to the evaluation of non‐cardiac chest pain, chronic cough, and rumination syndrome.

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Objectively diagnosing rumination syndrome in children using esophageal pH‐impedance and manometry

Cited by 23 publications

References 32 publications

Rumination Syndrome in Children and Adolescents: A Mini Review

Rumination Syndrome in Children and Adolescents: A Mini Review

Diagnosis and Treatment of Rumination Syndrome: A Critical Review

The role of ambulatory 24‐hour esophageal manometry in clinical practice

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