Subtotal Gastrectomy as “Last Resort” Consideration in the Management of Refractory Rumination Syndrome

Cooper, Chad J.; Otoukesh, Salman; Galvis, Juan; McCallum, Richard W.

doi:10.14740/gr594w

Cited by 3 publications

(2 citation statements)

References 10 publications

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“…Existe la descripción de un caso grave de rumiación refractaria con mejoría clínica después de la gastrectomía subtotal. 49 En ausencia de datos controlados junto con los riesgos de la cirugía, no se recomienda la cirugía como una terapia para el síndrome de rumiación. Figura 2.…”

Section: • Tratamiento Quirúrgicounclassified

Paciente con regurgitación: cómo estudiarla y cuáles son sus principales diagnósticos diferenciales

Dulbecco¹,

Rodríguez²,

Guzmán³

2021

Acta gastroenterol. latinoam.

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In gastroenterological practice, gastroesophageal reflux disease is one of the most frequent diagnoses. In this article the potential confounding of gastroesophageal reflux will be raised. According to the Montreal definition, “is a condition that develops when the reflux of stomach contents into the esophagus causes troublesome symptoms and/or complications.” However, it is becoming increasingly clear that sometimes symptoms suspected to be caused by gastroesophageal reflux disease are the expression of other functional and behavioral disorders or even structural lesions. From this complexity arise reflux confounding, where rumination and supragastric belching may present symptoms similar to gastroesophageal reflux disease, be initially treated with the proton pump inhibitor-based guidelines, and thus be mistakenly targeted. Likewise, regurgitation may be the symptomatic expression of different functional disorders and not exclusively a “typical” symptom of gastroesophageal reflux disease. Hence the need and the challenge for the treating physician to correctly identify the pathophysiological mechanisms responsible for the patient’s symptoms for a correct therapeutic approach.

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Section: • Tratamiento Quirúrgicounclassified

Paciente con regurgitación: cómo estudiarla y cuáles son sus principales diagnósticos diferenciales

Dulbecco¹,

Rodríguez²,

Guzmán³

2021

Acta gastroenterol. latinoam.

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“…Another single case report indicated clinical improvement after subtotal gastrectomy in a severe refractory case of rumination. 39 In the absence of any controlled data, coupled with the risks of surgery, we recommend avoiding surgery as a therapy for rumination syndrome. Currently, a role, if any, of surgery in refractory patients remains investigational.…”

Section: Medical and Surgical Therapymentioning

confidence: 99%

Diagnosis and Treatment of Rumination Syndrome

Halland

Pandolfino

Barba³

2018

Clinical Gastroenterology and Hepatology

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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.

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Belching Disorders and Rumination Syndrome: A Literature Review

Sawada,

Fujiwara

2023

Digestion

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Background: Belching disorders and rumination syndrome (RS) are disorders of gut-brain interaction (DGBIs) in Rome IV. Belching disorders are composed of excessive gastric belching (GB) and supragastric belching (SGB). Excessive GB is related to physiological phenomenon whereas excessive SGB and RS are behavioral disorders. Summary: A recent large internet survey found that prevalence of belching disorders and RS were 1% and 2.8%, respectively. It has been recognized that not a few patients with two behavioral disorders, excessive SGB and RS, could be misdiagnosed as proton pump inhibitors (PPI)-refractory gastroesophageal reflux disease (GERD). In patients with reflux symptoms, distinguishing these conditions is essential because they need psychological treatment (i.e., cognitive behavioral therapy (CBT) rather than acid suppressants. Clinicians should take a medical history meticulously first to identify possible excessive SGB and/or RS. High-resolution impedance manometry and/or 24-h impedance-pH monitoring can offer an objective diagnosis of the disorders. Several therapeutic options are available for excessive SGB and RS. The first-line therapy should be CBT using diaphragmatic breathing that can stop the behaviors involving complex muscle contraction (e.g., abdominal straining) to generate SGB or rumination. Overlap with eating disorders and/or other DGBIs such as functional dyspepsia can make management of the behavioral disorders challenging since such coexisting conditions often require additional treatments. Key Messages: Excessive SGB and RS are not unusual conditions. It is important to raise awareness of the behavioral disorders for appropriate management.

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Subtotal Gastrectomy as “Last Resort” Consideration in the Management of Refractory Rumination Syndrome

Cited by 3 publications

References 10 publications

Paciente con regurgitación: cómo estudiarla y cuáles son sus principales diagnósticos diferenciales

Paciente con regurgitación: cómo estudiarla y cuáles son sus principales diagnósticos diferenciales

Diagnosis and Treatment of Rumination Syndrome

Belching Disorders and Rumination Syndrome: A Literature Review

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