Rumination Syndrome “Real Prevalence”: A Need to Increase Awareness, Early Recognition, and Specific Management

The role of high‐resolution impedance manometry to identify rumination syndrome in children with unexplained foregut symptoms

“…A notable finding was the significant prevalence (67%) of digestive symptoms other than the characteristic clinical features of RS (regurgitation, rechewing and spitting out) highlighting, not only that RS can encompass a much broader presentation than traditionally accepted, but suggests that the criteria for its suspicion and diagnosis needs to be reassessed. This result is consistent with other studies that have shown a higher number of patients with RS reporting symptoms overlapping with GERD and functional dyspepsia, such as postprandial discomfort, nausea and early satiety 3,9,12 . Chial et al previously described a large cohort of children with RS who also presented with a number of associated symptoms, including abdominal pain, which was the most common 12 .…”

“…Noteworthy, half of the patients were referred from paediatric gastroenterologists highlighting the significant challenges posed to diagnose RS based exclusively on clinical criteria even for specialists. Multiple factors can make the clinical diagnosis of RS very challenging and mislead clinician from the exact diagnosis such as associated GI and extra‐GI symptoms, miscommunication of symptoms from patients/families, presence of comorbidities and coexistence with other functional and nonfunctional GI disorders 3 …”

“…Rumination syndrome (RS) is a disorder of gut-brain interaction characterised by repetitive episodes of effortless regurgitation of gastric contents into the mouth, which are subsequently either rechewed and reswallowed or expelled. [1][2][3][4][5][6] These episodes occur soon after meals and are not preceded by retching. [1][2][3][4][5][6] In clinical practice, children with RS present with a history of recurrent regurgitations or 'vomiting' following meals.…”

“…[1][2][3][4][5][6] These episodes occur soon after meals and are not preceded by retching. [1][2][3][4][5][6] In clinical practice, children with RS present with a history of recurrent regurgitations or 'vomiting' following meals. The diagnosis is often delayed or missed due to lack of awareness among clinicians.…”

How to recognize and treat rumination syndrome

“…The latest large epidemiological study suggests that RS is not a rare disease and, presumably, there are many RS patients misdiagnosed as PPI-refractory GERD [42]. Detecting RS patients largely relies on history taking, in which postprandial regurgitation and/or vomiting, young age, female sex, comorbidities such as other DGBI, eating disorders, and mental disorders all are clues that might suggest the possibility of RS.…”