Adolescent Rumination Syndrome

Abstract

Rumination syndrome is the non-purposeful regurgitation of recently ingested food from the stomach to the mouth, where it is either expelled or reswallowed. Adolescent rumination syndrome (ARS) is a rare condition of which many physicians are unaware. Patients often are misdiagnosed or undergo costly testing, and as a result, diagnosis and treatment are often delayed. While ARS is not life-threatening, it does have medical and emotional effects on the patient and the patient's family. Diagnosis of ARS is based upon the Rome III diagnostic criteria. Antroduodenal manometry, while not required for a diagnosis, can be helpful to confirm the diagnosis. The pathogenesis of this disorder is complex and not well understood. However, because of its behavioral component, treatment of ARS requires a multidisciplinary approach that includes both medical management of symptoms and implementation of strategies that address behavioral, psychological, and general quality-of-life components of the disorder.

Definitions and Outcome Measures in Pediatric Functional Upper Gastrointestinal Tract Disorders

“…Treatment options include the GABA-b agonist baclofen, prokinetics such as erythromycin, metoclopramide, domperidone and bethanechol, antiemetics such as ondansetron or cyproheptadine, and behavioral intervention habit reversal strategies, relaxation, diaphragmatic breathing, and biofeedback (13).…”

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

“…Rumination syndrome is a functional gastrointestinal disorder (FGID) of unknown etiology, characterized by recurrent regurgitation of recently ingested food into the mouth, not preceded by retching or nausea and in the absence of structural disease . Rumination syndrome was first described in mentally disabled children, and although it is now recognized in individuals of all ages and cognitive abilities, it tends to remain one of the less commonly recognized FGIDs in children . Epidemiological data on rumination syndrome in children are scarce.…”

Pediatric rumination subtypes: A study using high‐resolution esophageal manometry with impedance

“…Rumination is a functional gastrointestinal disorder characterized by the recurrent regurgitation of gastric contents into the mouth with spitting or reswallowing . It was initially described in children with developmental disabilities, but it is now recognized in many pediatric subgroups .…”

“…It was initially described in children with developmental disabilities, but it is now recognized in many pediatric subgroups . Even though the clinical history is suggestive of rumination, there is symptom overlap with intractable reflux so differentiating the two can be difficult but important because the therapies differ . Making a diagnosis of rumination in children is often problematic because children may be too young or lack the developmental skills to verbalize symptoms .…”

“…Making a diagnosis of rumination in children is often problematic because children may be too young or lack the developmental skills to verbalize symptoms . Furthermore, antroduodenal (AD) manometry which allows for visualization of R waves which are pathognomonic for rumination is invasive, is costly, and requires catheter placement under anesthesia . Therefore, the diagnosis of rumination is often given presumptively rather than confirmed by testing which may lead to patient/parental questioning of the diagnosis and its associated therapies …”