Diagnosis and Treatment of Rumination Syndrome

Abstract

Rumination syndrome is a functional gastrointestinal disorder characterized by effortless postprandial regurgitation. The disorder appears uncommon, although only limited epidemiologic data are available. Awareness of the characteristic symptoms is essential for recognizing the disorder, and thus avoiding the long delay in diagnosis, that many patients experience. Although objective testing by postprandial esophageal high-resolution impedance manometry is available in select referral centers, a clinical diagnosis can be made in most patients. The main therapy for rumination syndrome is behavioral modification with postprandial diaphragmatic breathing. This clinical practice update reviews the pathophysiology, diagnosis, and treatment of rumination syndrome. Best Practice Advice 1: Clinicians strongly should consider rumination syndrome in patients who report consistent postprandial regurgitation. Such patients often are labeled as having refractory gastroesophageal reflux or vomiting. Best Practice Advice 2: Presence of nocturnal regurgitation, dysphagia, nausea, or symptoms occurring in the absence of meals does not exclude rumination syndrome, but makes the presence of it less likely. Best Practice Advice 3: Clinicians should diagnose rumination syndrome primarily on the basis of Rome IV criteria after an appropriate medical work-up. Best Practice Advice 4: Diaphragmatic breathing with or without biofeedback is the first-line therapy in all cases of rumination syndrome. Best Practice Advice 5: Instructions for effective diaphragmatic breathing can be given by speech therapists, psychologists, gastroenterologists, and other health practitioners familiar with the technique. Best Practice Advice 6: Objective testing for rumination syndrome with postprandial high-resolution esophageal impedance manometry can be used to support the diagnosis, but expertise and lack of standardized protocols are current limitations. Best Practice Advice 7: Baclofen, at a dose of 10 mg 3 times daily, is a reasonable next step in refractory patients.

Academic performance and subtypes of psychological traits in undergraduate nursing students: A latent class analysis

“…Study proposed the Response Style Theory of Depression, which showed that people who are ruminating have the tendency to experience more negative emotions [21]. Hence, rumination scores should re ect the students' emotional state after failing the exam.…”

30-Year-Old Woman With Intractable Vomiting

“…Although the underlying pathogenesis remains unclear, the regurgitation of ingested material occurs because of a combination of increased intraabdominal pressure and negative intrathoracic pressure. 11 The diagnosis of rumination syndrome should be made clinically, using the Rome IV criteria. 11 The Rome IV criteria for rumination syndrome require persistent or recurrent regurgitation of recently ingested food into the mouth with subsequent spitting or remastication and swallowing and regurgitation not preceded by retching.…”

“…11 The diagnosis of rumination syndrome should be made clinically, using the Rome IV criteria. 11 The Rome IV criteria for rumination syndrome require persistent or recurrent regurgitation of recently ingested food into the mouth with subsequent spitting or remastication and swallowing and regurgitation not preceded by retching. 12 High-resolution esophageal manometry with postprandial protocol can be used to support the diagnosis, but the lack of its widespread availability and standardized protocols limit its generalizability.…”

“…12 High-resolution esophageal manometry with postprandial protocol can be used to support the diagnosis, but the lack of its widespread availability and standardized protocols limit its generalizability. 11 A limited work-up to rule out mechanical obstruction should also be performed, generally with upper endoscopy.…”

“…By decreasing the pressure gradient between the stomach and the esophagus, rumination events decrease. 11 In patients with refractory symptoms, baclofen at a dose of 5 to 10 mg 3 times daily can be considered. 11 In conjunction with these therapeutic interventions, patients should also be educated about their disease process, and reassurance should be offered.…”