Rumination or belching-regurgitation? Differential diagnosis using oesophageal impedance-manometry

Abstract

Postprandial impedance-manometry monitoring improves diagnosis of rumination because it allows distinction between rumination and postprandial belching and regurgitation. During rumination, oesophageal liquid retrograde flow is first driven by an early small rise in intragastric pressure preceding the peak pressure observed during straining.

Esophageal Impedance Monitoring: Clinical Pearls and Pitfalls

“…Th is is associated with impedance-detected movement of gastric contents proximally through the esophagus ( Figure 5 ). Several studies have subsequently reproduced these fi ndings by administering standard meals during HRIM studies in patients with rumination syndrome (76)(77)(78). Th is high gastric pressure distinguishes ruminators from patients with gastroesophageal refl ux ( 79 ).…”

Impedance measurements and high-resolution manometry help to better define rumination episodes

“…The authors observed an increase in intra-abdominal pressure followed by increase in intra-esophageal pressure in all channels (common cavity) [12] associated with esophageal reflux on impedance monitoring [13,14]. Recently, Rommel et al were able to successfully differentiate between belching-regurgitation and rumination syndrome using manometry/impedance measurement [15]. These authors demonstrated that, with the use of impedance monitoring, belching episodes were characterized by gas reflux and rumination episodes were characterized by fluid reflux [15].…”

Utilization of Esophageal Function Testing for the Diagnosis of the Rumination Syndrome and Belching Disorders

“…Usually, history is enough to establish a diagnosis but sometimes impedance monitoring is required to distinguish excessive supragastric belching from GERD and rumination. 11 With combined HRM and pH impedance, the typical mechanisms of supragastric belches can be identified. Because of a contraction of the diaphragm, Esophageal Function Testing for Rumination and Belching the esophagogastric junction moves distally and a decrease in pressure in the esophagus is observed.…”

“…Currently, it is preferred to use conventional manometry or HRM combined with pH impedance to distinguish rumination syndrome from belching/regurgitation disorders and GERD. 9,11 With combined manometry (conventional/HRM) and pH impedance, 3 variations of the rumination syndrome can be identified: (1) rumination without any leading events (classic rumination), (2) rumination occurring exclusively after a reflux episode (reflux rumination or secondary rumination), and (3) rumination caused by air swallowing and subsequent gastric straining (supragastric rumination). 1,17,18 Each subtype has a specific pattern, which can be identified on manometry and impedance measurements.…”

“…1,10 The underlying mechanism is characterized by an increase in intragastric pressure, as a result of gastric straining. 11,12 When the intragastric pressure overcomes the pressure of the lower esophageal sphincter (LES), gastric content can flow into the esophagus. As a result, relaxation of the upper esophageal sphincter (UES) occurs and gastric content can subsequently flow from the esophagus into the pharynx and mouth.…”