Materiały źródłowe

• #1 Rumination syndrome: pathophysiology, diagnosis and practical management | Frontline Gastroenterology

  https://fg.bmj.com/content/13/5/440

  Rumination syndrome should be considered in any patient who presents with recurrent regurgitation without associated retching or significant nausea. […] Despite rumination syndrome being a relatively common disorder of gut-brain interaction, evidence suggests it is not well understood, resulting in patients often having to visit a number of clinicians and undergo several investigations before a diagnosis is eventually reached. […] This paper aims to set out the key diagnostic features of rumination syndrome, important differential diagnoses to consider, useful investigations to help dispel uncertainty and current evidence-based therapies. […] The key feature of rumination syndrome is the effortless regurgitation of recently ingested food or fluids which results in patients either masticating and reswallowing the regurgitant or spitting it from their mouths.

• #2 Diagnosis and Treatment of Rumination Syndrome: A Critical Review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6492032/

  Rumination syndrome (RS) is characterized by the repeated regurgitation of material during or soon after eating with the subsequent rechewing, reswallowing, or spitting out of the regurgitated material. Rumination syndrome is classified as both a Functional Gastroduodenal Disorder (by the Rome Foundations Functional Gastrointestinal Disorders: Disorders of Gut-Brain Interaction, 4th edition) and a Feeding and Eating Disorder (by the Diagnostic and Statistical Manual of Mental Disorders, 5th edition). […] Rumination syndrome is a disorder that is often inaccurately diagnosed or missed, resulting in patients experiencing protracted symptoms and not receiving treatment for long periods. There is a lack of clear consensus for RS diagnosis, mechanisms that maintain RS, and treatment. […] We suggest assessment strategies to facilitate accurate diagnosis, and provide a schematic for intervention options. Overall, we recommend clinicians recognize the heterogeneous features of RS when considering diagnosis, assess for RS symptoms by clinical history, and treat RS with targeted diaphragmatic breathing while using other methods as augmented intervention or alternative treatment.

• #3 Rumination syndrome – UpToDate

  https://www.uptodate.com/contents/rumination-syndrome

  Rumination syndrome is frequently misdiagnosed as gastroesophageal reflux disease or vomiting, resulting in a delay in diagnosis. […] This topic will review the epidemiology, etiology, diagnosis, and management of rumination syndrome. […] Rumination syndrome can affect children and adults. […] In a study that surveyed 2163 children and adolescents, 110 (5 percent) fulfilled clinical criteria for rumination syndrome. […] The prevalence of rumination was 3.1 and 5.8 percent, respectively. […] Rumination syndrome has been associated with anxiety, depression, obsessive compulsive disorder, post-traumatic stress disorder, adjustment disorder, attention deficit-hyperactivity disorder, and constipation from a rectal evacuation disorder. […] The pathogenesis of rumination syndrome is unclear, but unperceived abdominal wall activation in the postprandial period appears to be a key pathogenetic feature. […] On postprandial esophageal high resolution impedance manometry, rumination follows gastric pressurizations exceeding 30 mmHg, which is associated with lower and upper esophageal relaxation at the time of gastric pressurization.

• #4 Rumination Syndrome: An Update on Diagnostic and Treatment Strategies – Practical Gastro

  https://practicalgastro.com/2016/09/02/rumination-syndrome-an-update-on-diagnostic-and-treatment-strategies/

  Rumination syndrome (RS) can occur as a primary disorder or as a conditioned response in the setting of other vomiting disorders, particularly gastroparesis. […] This article will focus on the importance of history taking to diagnose rumination syndrome and review treatment strategies including breathing and relaxation skills. […] Rumination syndrome is a disorder characterized by the regurgitation of swallowed food with the decision to re-swallow the material or vomit within minutes after eating. […] The diagnosis of rumination syndrome was made based on his symptoms in the setting of a negative evaluation. […] A thorough history is important in differentiating RS from other disorders. […] The average time from onset of symptoms until the diagnosis of RS is approximately 17 months.

• #5 Rumination syndrome – Wikipedia

  https://en.wikipedia.org/wiki/Rumination_syndrome

  Supportive criteria include a regurgitant that does not taste sour or acidic, is generally odourless, is effortless, or at most preceded by a belching sensation, that there is no retching preceding the regurgitation, and that the act is not associated with nausea or heartburn. […] Patients visit an average of five physicians over 2.75 years before being correctly diagnosed with rumination syndrome.

• #6 Rumination Syndrome – Guts UK

  https://gutscharity.org.uk/advice-and-information/conditions/rumination-syndrome/

  An organisation called ROME who develop diagnostic criteria for functional gastrointestinal disorders recommend the following must be met for a positive diagnosis of rumination syndrome. […] For rumination to be diagnosed all of the following must be fulfilled for the last 3 months, with symptom onset at least 6 months prior to diagnosis: […] Persistent or recurrent regurgitation of recently ingested food into the mouth with subsequent spitting or re-mastication and swallowing. […] Regurgitation is not preceded by retching. […] No evidence of an inflammatory (inflammation), anatomic (structural abnormality), metabolic, or neoplastic (cancer) process that explains the subject’s symptoms. […] The presence of other gastrointestinal symptoms not included in the Rome IV classification of rumination, such as nausea, heartburn, abdominal discomfort, bloating, diarrhoea, belching, and abdominal pain, does not exclude the possibility that the doctor will diagnose rumination syndrome. […] Best Practice Advice 3: Clinicians should diagnose rumination syndrome primarily on the basis of Rome IV criteria after an appropriate medical work-up.

• #7 Rumination Disorder – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK576404/

  Rumination syndrome is a functional gastrointestinal disorder defined as the effortless regurgitation of recently ingested food from the stomach back into the oral cavity in the absence of organic disease. The regurgitation usually occurs within the first 15 minutes after the completion of a meal. […] Rumination syndrome can be present in both children and adults and is classified as a functional gastrointestinal disorder by the Rome IV criteria and as an eating disorder according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-V). Rumination disorder is often misdiagnosed as gastroesophageal reflux disease or vomiting, which results in unnecessary testing and treatments, leading to delay in therapies that will help alleviate the problem. […] According to the ROME IV criteria for rumination syndrome, a diagnosis is possible on clinical grounds without invasive testing. In contrast, the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) criteria require that repeated regurgitation should not be due to a medical condition which most often requires some form of testing for exclusion.

• #8 AGA Clinical Practice Update: Diagnosis of rumination syndrome | MDedge

  https://www.mdedge.com/gihepnews/article/173974/gastroenterology/aga-clinical-practice-update-diagnosis-rumination-syndrome

  Patients who have dysphagia, nausea, nocturnal regurgitation, or gastric symptoms outside of meals are less likely to have rumination syndrome, but those symptoms do not exclude the condition. […] Rome IV criteria are advised to diagnose rumination syndrome after medical work-up, which includes “persistent or recurrent regurgitation of recently ingested food into the mouth with subsequent spitting or remastication and swallowing” not preceded by retching where patients fulfill these symptom criteria for 3 months with a minimum of 6 months of symptoms before diagnosis. […] Patients should receive first-line therapy for rumination syndrome consisting of diaphragmatic breathing with or without biofeedback. […] Patients should be referred to a speech therapist, gastroenterologist, psychologist, or other knowledgeable health practitioners to learn effective diaphragmatic breathing.

• #9 Rumination Disorder – National Eating Disorders Association

  https://www.nationaleatingdisorders.org/rumination-disorder/

  Rumination disorder involves the regular regurgitation of food that occurs for at least one month. Regurgitated food may be re-chewed, re-swallowed, or spit out. Typically, when someone regurgitates their food, they do not appear to be making an effort, nor do they appear to be stressed, upset, or disgusted. […] The DSM-5 TR criteria for rumination disorder are: Repeated regurgitation of food for a period of at least one month. Regurgitated food may be re-chewed, re-swallowed, or spit out. The repeated regurgitation is not due to a medication condition (e.g., gastrointestinal condition). The behavior does not occur exclusively in the course of anorexia nervosa, bulimia nervosa, binge eating disorder, or avoidant/restrictive food intake disorder. If occurring in the presence of another mental disorder (e.g., intellectual developmental disorder), it is severe enough to warrant independent clinical attention.

• #10 Rumination Syndrome: Symptoms, Causes, Treatment, and More

  https://resources.healthgrades.com/right-care/mental-health-and-behavior/rumination-syndrome

  Rumination syndrome is often difficult to diagnose because the symptoms are similar to vomiting or other digestive problems, such as heartburn or gastroesophageal reflex disease (GERD). […] According to the National Eating Disorders Association, the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5), states that the diagnostic criteria for rumination disorder include the following: The repeated regurgitation of food that lasts for a period of at least 1 month. A person may then rechew, re-swallow, or spit out the food. The repeated regurgitation is not due to a gastrointestinal or another medical condition. The behavior does not occur exclusively in the course of anorexia nervosa, bulimia nervosa, binge eating disorder, or avoidant/restrictive food intake disorder.

• #11 Rumination Disorder – PsychDB

  https://www.psychdb.com/eating-disorders/rumination

  Rumination Disorder is a feeding and eating disorder characterized by repeated regurgitation of food occurring after feeding or eating over a period of at least one month. […] The disorder may be diagnosed across the life span. […] Repeated regurgitation of food over a period of at least 1 month. Regurgitated food may be re-chewed, re-swallowed, or spit out. […] The repeated regurgitation is not attributable to an associated gastrointestinal or other medical condition (e.g. – gastroesophageal reflux, pyloric stenosis). […] The eating disturbance does not occur exclusively during the course of anorexia nervosa, bulimia nervosa, binge-eating disorder, or avoidant/restrictive food intake disorder. […] If the symptoms occur in the context of another mental disorder (e.g. – intellectual developmental disorder or another neurodevelopmental disorder), they are sufficiently severe to warrant additional clinical attention.

• #12 Rumination Syndrome | Loma Linda University Children’s Health

  https://lluch.org/conditions/rumination-syndrome

  Rumination syndrome is a rare problem. But it may be underdiagnosed because it is mistaken for another problem. […] Rumination is most often diagnosed in children. But it’s also diagnosed in adults. […] Throwing up is much more common. So rumination syndrome is often misdiagnosed as a vomiting disorder such as delayed digestion (gastroparesis) or heartburn (GERD or gastroesophageal reflex disease). […] To diagnose rumination, healthcare providers need to ask the right questions. For instance, asking what the food tastes like when it comes up is important. If it still tastes good, this means the food was not digested. This means that rumination syndrome is a good possibility. Vomited food has been digested and often is not kept in the mouth. […] The symptoms of rumination syndrome don’t get better with normal treatment of reflux. […] Rumination syndrome should be considered in anyone who vomits after eating, has regurgitation, and weight loss.

• #13 Rumination syndrome: pathophysiology, diagnosis and practical management | Frontline Gastroenterology

  https://fg.bmj.com/content/13/5/440

  Rumination syndrome should be considered in any patient who presents with recurrent regurgitation without associated retching or significant nausea. […] Despite rumination syndrome being a relatively common disorder of gut-brain interaction, evidence suggests it is not well understood, resulting in patients often having to visit a number of clinicians and undergo several investigations before a diagnosis is eventually reached. […] This paper aims to set out the key diagnostic features of rumination syndrome, important differential diagnoses to consider, useful investigations to help dispel uncertainty and current evidence-based therapies. […] The key feature of rumination syndrome is the effortless regurgitation of recently ingested food or fluids which results in patients either masticating and reswallowing the regurgitant or spitting it from their mouths.

• #14 Rumination Syndrome: An Update on Diagnostic and Treatment Strategies – Practical Gastro

  https://practicalgastro.com/2016/09/02/rumination-syndrome-an-update-on-diagnostic-and-treatment-strategies/

  Rumination can be a primary or a secondary disorder associated with states of chronic nausea and vomiting, such as gastroparesis. […] In both types of rumination syndrome, there is accompanying heartburn, due to refluxed material contacting the esophageal mucosa during the regurgitation event, and PPIs may be beneficial. […] While the diagnosis of rumination syndrome relies on thorough history and physical, invasive testing at a tertiary care facility may assist in eliminating the uncertainty regarding the diagnosis or unwillingness by the patient and/or the family to accept this diagnosis. […] The mainstay of treatment in RS consists of behavioral therapy focusing on breathing and relaxation techniques. […] A multidisciplinary team consisting of the gastroenterologist, nutritionist and mental health specialist is recommended to manage rumination syndrome.

• #15 Rumination-Syndrome-An-Update-on-Diagnostic-and-Treatment-Strategies

  https://www.ficomputing.net/article/165895/Rumination-Syndrome-An-Update-on-Diagnostic-and-Treatment-Strategies

  Patients undergo expensive, unnecessary, and sometimes invasive testing prior to being diagnosed. […] In both types of rumination syndrome, there is accompanying heartburn, due to refluxed material contacting the esophageal mucosa during the regurgitation event, and PPIs may be beneficial. […] While the diagnosis of rumination syndrome relies on thorough history and physical, invasive testing at a tertiary care facility may assist in eliminating the uncertainty regarding the diagnosis or unwillingness by the patient and/or the family to accept this diagnosis. […] The diagnosis is made by a careful history with focus on timing of the post-prandial regurgitation, which is fountain-like and effortless with the regurgitated material being re-swallowed or vomited.

• #16 Rumination syndrome: Diagnostic and therapeutic difficulties of a not so uncommon disorder | Anales de Pediatría

  https://www.analesdepediatria.org/en-rumination-syndrome-diagnostic-therapeutic-difficulties-articulo-S234128791730220X

  Rumination syndrome is an uncommon gastrointestinal functional disorder that may be difficult to diagnose, as not many physicians are aware of this condition. […] The diagnosis may be challenging in some cases due to the lack of awareness of this disorder by physicians. Multiple diagnostic tests may be performed, most of them with normal findings, and different treatments prescribed that are usually ineffective, leading to delayed or incorrect diagnosis in most patients. […] The diagnosis of rumination syndrome is based on the Rome IV criteria. […] The importance of direct observation of rumination episodes while the patient eats should not be disregarded. […] Antroduodenal manometry consists in the measurement of intraluminal changes through a catheter inserted orally through the stomach and small intestine, and is one of the techniques that may be of use in the diagnosis of rumination.

• #17 Rumination syndrome: Diagnostic and therapeutic difficulties of a not so uncommon disorder | Anales de Pediatría

  https://analesdepediatria.org/en-rumination-syndrome-diagnostic-therapeutic-difficulties-articulo-S234128791730220X

  Rumination syndrome is an uncommon gastrointestinal functional disorder that may be difficult to diagnose, as not many physicians are aware of this condition. […] The diagnosis may be challenging in some cases due to the lack of awareness of this disorder by physicians. […] The diagnosis of rumination syndrome is based on the Rome IV criteria. […] The importance of direct observation of rumination episodes while the patient eats should not be disregarded. […] Antroduodenal manometry consists in the measurement of intraluminal changes through a catheter inserted orally through the stomach and small intestine, and is one of the techniques that may be of use in the diagnosis of rumination. […] The most salient finding as regards the diagnostic tests performed in the cases under study is that every single patient was subjected to at least one test that was not needed for the diagnosis of rumination, while only 3 patients were eventually assessed by antroduodenal manometry after performance of other tests that were unnecessary. […] Due to the rarity of the disease and a limited knowledge of its clinical presentation on the part of clinicians, patients are misdiagnosed and are often subjected to tests and treatments that are unnecessary, invasive and costly.

• #18 Rumination Disorder – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK576404/

  The recommended evaluation of patients with suspected rumination syndrome includes: Assessment of potential underlying eating disorders (bulimia nervosa, anorexia nervosa), Endoscopy and/or CT enterography to exclude mechanical obstruction, High-resolution esophageal manometry (HRIM) with impedance testing. […] The diagnosis of rumination syndrome can be confirmed using this study if there is evidence of reflux extending to the proximal esophagus that is closely associated with an intragastric pressure of greater than 30 mmHg in adults or 25 mmHg in children.

• #19 Rumination Syndrome: Symptoms, Causes, Treatment, and More

  https://resources.healthgrades.com/right-care/mental-health-and-behavior/rumination-syndrome

  To assist the diagnosis process, it may be helpful to keep a note or diary of the symptoms to share with your medical team. […] A doctor may ask questions about your symptoms, examine your medical history and any recent experience of stressful events, and conduct a physical exam to rule out other conditions. […] To help diagnose rumination syndrome, your doctor may also refer you to a gastroenterologist, a specialist in disorders and diseases of the digestive system. […] A gastroenterologist will generally begin by asking questions about your symptoms. They may suggest tests, such as a blood test or imaging, to rule out other possible causes of your symptoms. A doctor might assess you for signs of dehydration, malnutrition, or other complications of rumination syndrome.

• #20 Rumination syndrome | Beacon Health System

  https://www.beaconhealthsystem.org/library/diseases-and-conditions/rumination-syndrome?content_id=CON-20377320

  To diagnose rumination syndrome, a healthcare professional asks about current symptoms and takes a medical history. This first examination, combined with observing behavior, is often enough to diagnose rumination syndrome. […] Sometimes, tests such as high-resolution esophageal manometry and impedance measurement are used to confirm the diagnosis. This testing shows whether there is increased pressure in the abdomen. It also can provide an image of the irregular function for use in behavioral therapy. […] Other tests that may be used to rule out other possible causes of your or your child’s symptoms include: Upper endoscopy. This test allows a close look at the esophagus, stomach and upper part of the small intestine to rule out any obstruction. A small tissue sample called a biopsy may be removed for further study. Gastric emptying. This procedure can measure how long it takes food to empty from the stomach. Another version of this test also can measure how long it takes food to travel through the small intestine and colon.

• #21 Rumination syndrome: pathophysiology, diagnosis and practical management | Frontline Gastroenterology

  https://fg.bmj.com/content/13/5/440

  Invasive investigations are not usually required to establish the diagnosis of rumination syndrome. A comprehensive history to elicit the key clinical features is sufficient in the majority of cases. […] The gold standard investigation for rumination syndrome, in cases where a history is insufficient to make a firm diagnosis, is high-resolution oesophageal manometry (HROM) with concurrent impedance monitoring. […] Following a positive clinical diagnosis of rumination syndrome, one of the most crucial aspects of treatment is an effective doctor-patient interaction. […] These explanations can be reinforced by the provision of a patient information leaflet recently developed by Guts-UK. […] Behavioural interventions have the greatest evidence base for the treatment of rumination syndrome.

• #22 Rumination syndrome. A review article | Revista de Gastroenterología de México

  https://www.revistagastroenterologiamexico.org/en-rumination-syndrome-a-review-article-articulo-S2255534X21000311

  In selected cases, antroduodenal manometry or high-resolution esophageal manometry, ideally with impedance monitoring in the postprandial period, can be employed. […] The diagnostic criteria of high-resolution esophageal impedance manometry for rumination syndrome are based on the presence of reflux into the proximal esophagus, associated with gastric pressurization above 30mmHg. […] Rumination syndrome is a clinical diagnosis. It should be suspected in patients that present with postprandial effortless regurgitation, with no retching.

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• #24 Rumination Syndrome | Abdominal Key

  https://abdominalkey.com/rumination-syndrome/

  Rumination syndrome is a clinical diagnosis and very minimal testing should be needed in the classic cases. A patient who satisfies the symptoms-based Rome criteria for this condition should need no further investigation. […] Antroduodenal manometry is not always necessary to make the diagnosis, but it can be considered as the big convincer in cases when the families or the patients are not yet confident of the diagnosis of rumination syndrome. […] The characteristic manometric abnormality is a synchronous increase in pressure (r waves) across both gastric and duodenal recording sites when the rumination occurs. […] It has been suggested that the diagnosis of rumination syndrome can be made when reflux events extending to the proximal esophagus are associated with an abdominal pressure increase 30 mm, because such increase is usually not seen in patients with GERD. The impedance study will also confirm the characteristic absence of nighttime reflux events in patients with rumination syndrome.

• #25 Rumination Syndrome Diagnosis Supported by Colon Manometry in a Pediatric Patient

  https://scholarlyexchange.childrensmercy.org/posters/344/

  Rumination syndrome is a disorder of gut-brain interaction characterized by effortless repetitive postprandial regurgitation, reswallowing, and/or spitting. […] The diagnosis of rumination is clinical, but supportive evidence can be obtained through esophageal or antroduodenal manometry. […] This is the first reported case in which rumination syndrome was diagnosed using colon manometry. […] The presence of repetitive regurgitation and reswallowing during the postprandial phase alone would have been sufficient for establishing the diagnosis. […] Additionally, the simultaneous increase in pressure („r” waves) observed across multiple colon sensors supports the diagnosis of rumination syndrome. […] Rumination syndrome is diagnosed based on the clinical presentation of effortless repetitive postprandial regurgitation, reswallowing, and/or spitting. […] Colon manometry, which detects spontaneous increases in pressure across multiple sensors due to abdominal muscle contractions, can be a valuable tool in supporting the diagnosis of rumination syndrome.

• #26 Rumination Disorder – PsychDB

  https://www.psychdb.com/eating-disorders/rumination

  It is important to differentiate regurgitation in rumination disorder from other conditions characterized by gastroesophageal reflux (GERD) or vomiting. Conditions such as pyloric stenosis, hiatal hernia, gastroparesis, and Sandifer syndrome should be ruled out by appropriate physical examinations, investigations, and laboratory tests. […] As per the differential diagnosis, more detailed gastrointestinal investigations may be required. […] Behavioural therapy and diaphragmatic breathing have been recommended. […] There may be some evidence for the use of metoclopramide, cimetidine, and haloperidol.

• #27 Rumination disorder

  https://www.visualdx.com/visualdx/diagnosis/?moduleId=101&diagnosisId=56098

  Rumination disorder is an eating disorder involving episodic (daily) regurgitation of food into the mouth, which may be rechewed, swallowed, or spit out. […] Rumination syndrome can commonly be mistaken for gastroesophageal reflux disease (GERD), leading to delay in diagnosis. […] In rumination disorder, the regurgitation of food contents occurs postprandially within several minutes. Patients will describe an abdominal discomfort preceding the regurgitation of gastric contents into the oral cavity, after which these contents are typically swallowed or spit out and the abdominal pain is relieved. […] Emesis and persistent or overt abdominal pain are not characteristic symptoms of rumination syndrome. Dyspepsia and abdominal fullness are often reported in patients with rumination syndrome. […] Many children under 1 year of age with rumination syndrome will experience spontaneous resolution of symptoms. Adolescents and adults with rumination syndrome can have improvement in symptoms with behavioral modifications. Recurrence in these patients is common.

• #28 Rumination Disorder: Symptoms, Causes, Treatment

  https://www.transcendeatingdisorders.com/resources/rumination

  Rumination disorder is a disorder characterized by an individuals uncontrollable and frequent regurgitation of food. […] Rumination disorder, also referred to as rumination syndrome, is considered a psychiatric disorder, classified under feeding and eating disorders in the „Diagnostic and Statistical Manual of Mental Disorders, Edition 5” (DSM 5), but a gastroenterologist and other specialists are typically involved in diagnosis particularly to eliminate medical causes for regurgitation. […] Diagnosing rumination disorder can be a complicated process, especially because other medical conditions must first be ruled out by medical specialists, such as gastroenterologists. […] Once the doctor eliminates physical causes of the regurgitation and related symptoms, a mental health professional, such as a psychologist or psychiatrist, can diagnose rumination disorder. The diagnosis is made based on the criteria discussed in the DSM-5: Food is regurgitated for a minimum of one month, with or without rechewing and swallowing. […] Studies suggest that people with rumination disorder visit an average of five doctors over 2.7 to 4.9 years before a correct diagnosis is reached.

• #29 Rumination Disorder: Treatment in Children vs. Adults, and More

  https://www.healthline.com/health/rumination-disorder

  Rumination disorder has been linked to other eating disorders, in particular bulimia nervosa, but how these conditions are related is still unclear. The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) identifies the following diagnostic criteria for rumination disorder: […] There’s no test for rumination disorder. Your doctor will perform a physical exam and ask you to describe you or your child’s symptoms and medical history. The more detailed your answers, the better. A diagnosis is mostly based on the signs and symptoms you describe. People with rumination disorder often don’t have other symptoms such as true vomiting or an acid sensation or taste in their mouth or throat. […] Rumination disorder is often misdiagnosed and mistaken for other conditions. More awareness is needed to help people with the condition and doctors identify symptoms.

• #30 AGA Clinical Practice Update: Diagnosis of rumination syndrome | MDedge

  https://www.mdedge.com/gihepnews/article/173974/gastroenterology/aga-clinical-practice-update-diagnosis-rumination-syndrome

  Rumination syndrome differs from vomiting, the authors noted, because the retrograde flow of ingested gastric content does not have an acidic taste and may in fact taste like food or drink recently ingested. Rumination can occur without any preceding events, after a reflux episode or by the swallowing of air that causes gastric straining but typically happens within 1 hour to 2 hours after a meal. Patients can experience weight loss, dental erosions and caries, heartburn, nausea, bloating, diarrhea, abdominal pain, abdominal discomfort, and belching, among other symptoms, in the presence of rumination syndrome, the authors said. […] Dr. Halland and his colleagues provided seven best practice recommendations for rumination syndrome in their updates, which include: […] Patients who show symptoms of consistent postprandial regurgitation, often misdiagnosed with refractory gastroesophageal reflux or vomiting, should be considered for rumination syndrome.

• #31 Diagnosis and Treatment of Rumination Syndrome: A Critical Review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6492032/

  There is a lack of clear consensus for RS diagnosis, mechanisms that maintain RS, and treatment. […] We recommend assessing for RS when patients present with reflux, vomiting, or regurgitation, terms often used by patients with RS. […] In our experience, existing self-report questionnaires (e.g., the ROME-IV diagnostic questionnaire) can be used as a screening tool, but RS diagnosis is made based on clinical history. […] Effective assessment of RS is crucial to prevent the long periods patients report going without accurate diagnosis. […] When patients with RS finally receive accurate diagnosis, the diagnosis itself can be therapeutic. […] We recommend the use of clinical history alone unless the patient also presents with symptoms of another gastrointestinal condition that could be comorbid or underlie regurgitation.

• #32 Rumination syndrome: pathophysiology, diagnosis and practical management | Frontline Gastroenterology

  https://fg.bmj.com/content/13/5/440

  The two interventions most often used are diaphragmatic breathing and biofeedback. […] When the response to diaphragmatic breathing is incomplete, more advanced behavioural therapy with biofeedback may be an effective tool for rumination syndrome. […] There are very few studies on effective medical therapy for rumination syndrome. Baclofen may however be a reasonable option as second-line management option following behavioural approaches. […] Limited evidence from case series suggests that in refractory cases, rumination syndrome can be treated with Nissens fundoplication in order to enhance the resting pressure of the LOS and to partially negate the intragastric propulsive force provided by contraction of anterior wall musculature by reducing concurrent LOS relaxation. […] Rumination syndrome is a poorly recognised, infrequently diagnosed, yet easily manageable disorder of gut-brain interaction. Greater awareness among medical professionals will ensure prompt diagnosis, prevent malnutrition and reduce inappropriate referrals for psychiatric assessments or invasive investigations.

• #33 Common, serious gut disorder is under- and often misdiagnosed

  https://www.massgeneral.org/news/press-release/common-serious-gut-disorder-is-under-and-often-misdiagnosed

  Rumination syndrome is little known, but relatively common. It involves effortless, repeated regurgitation. […] Proper diagnosis is important because the treatment is very different from what is advised for similar gastrointestinal conditions. […] Patients who regurgitate regularly but without any known cause may have a condition called rumination. Unfortunately, rumination is often confused with other gastrointestinal conditions, which means many patients may not be getting prompt treatment. […] One reason rumination symptoms are missed is because they overlap with other DGBIs, such as functional dyspepsia (stomach pain or indigestion) or gastroparesis, which is when patients feel nauseous and full after eating just a small amount. […] Thirty-one of the 242 (12.8%) patients met criteria for rumination syndrome, which is determined using a gastric symptom scoring system. […] The treatment for rumination is behavioral and involves the practice of diaphragmatic, or deep, breathing. Comprehensive cognitive behavioral therapy for rumination syndrome (CBT-RS) is also recommended.

• #34 Rumination syndrome: pathophysiology, diagnosis and practical management | Frontline Gastroenterology

  https://fg.bmj.com/content/13/5/440

  Invasive investigations are not usually required to establish the diagnosis of rumination syndrome. A comprehensive history to elicit the key clinical features is sufficient in the majority of cases. […] The gold standard investigation for rumination syndrome, in cases where a history is insufficient to make a firm diagnosis, is high-resolution oesophageal manometry (HROM) with concurrent impedance monitoring. […] Following a positive clinical diagnosis of rumination syndrome, one of the most crucial aspects of treatment is an effective doctor-patient interaction. […] These explanations can be reinforced by the provision of a patient information leaflet recently developed by Guts-UK. […] Behavioural interventions have the greatest evidence base for the treatment of rumination syndrome.

• #35 Diagnosis and Treatment of Rumination Syndrome: A Critical Review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6492032/

  Given current evidence, we recommend diaphragmatic breathing as the first-line strategy for RS treatment. […] We recommend clinicians use baclofen only with patients who have not achieved a substantial reduction in regurgitation frequency after behavioral intervention. […] Given current evidence, we recommend clinicians do not use surgical approaches, which aligns with previous conclusions in the literature.

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• #37 Rumination Disorder – National Eating Disorders Association

  https://www.nationaleatingdisorders.org/rumination-disorder/

  Once a physical cause for rumination disorder has been ruled out, the most common way rumination disorder is treated involves a combination of breathing exercises and habit reversal. A person with rumination disorder is taught to recognize the signs and situations when rumination is likely, and then they learn diaphragmatic breathing techniques to use after eating that prevent them from regurgitating their food. They eventually learn to prevent the rumination habit by replacing it with deep breathing techniques. If a person does not respond to these breathing techniques, other behavioral therapies such as biofeedback can be helpful. Beyond behavioral therapies, if an individual continues to experience symptoms providers may recommend taking certain types of medication (Baclofen and tricyclic antidepressants). […] Since treatment providers specializing in rumination disorder are limited, if you or a loved one is exhibiting any concerning behaviors associated with rumination consult with a primary care doctor or pediatrician as soon as possible.

• #38 Rumination Syndrome: An Update on Diagnostic and Treatment Strategies – Practical Gastro

  https://practicalgastro.com/2016/09/02/rumination-syndrome-an-update-on-diagnostic-and-treatment-strategies/

  The focus of treatment is using breathing and relaxation techniques to distract patients as they attempt to eat small meals. […] Physicians should also recognize the subset of patients in whom a feeding jejunostomy tube is necessary to maintain nutrition and electrolyte balance while the patient masters the breathing and relaxation approaches.

• #39 Rumination syndrome: pathophysiology, diagnosis and practical management | Frontline Gastroenterology

  https://fg.bmj.com/content/13/5/440

  The two interventions most often used are diaphragmatic breathing and biofeedback. […] When the response to diaphragmatic breathing is incomplete, more advanced behavioural therapy with biofeedback may be an effective tool for rumination syndrome. […] There are very few studies on effective medical therapy for rumination syndrome. Baclofen may however be a reasonable option as second-line management option following behavioural approaches. […] Limited evidence from case series suggests that in refractory cases, rumination syndrome can be treated with Nissens fundoplication in order to enhance the resting pressure of the LOS and to partially negate the intragastric propulsive force provided by contraction of anterior wall musculature by reducing concurrent LOS relaxation. […] Rumination syndrome is a poorly recognised, infrequently diagnosed, yet easily manageable disorder of gut-brain interaction. Greater awareness among medical professionals will ensure prompt diagnosis, prevent malnutrition and reduce inappropriate referrals for psychiatric assessments or invasive investigations.

• #40 Diagnosis and Treatment of Rumination Syndrome: A Critical Review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6492032/

  Given current evidence, we recommend diaphragmatic breathing as the first-line strategy for RS treatment. […] We recommend clinicians use baclofen only with patients who have not achieved a substantial reduction in regurgitation frequency after behavioral intervention. […] Given current evidence, we recommend clinicians do not use surgical approaches, which aligns with previous conclusions in the literature.

• #41 Rumination Syndrome: Unknown Pathology Easy to Diagnose With High-resolution Impedance Manometry

  https://www.jnmjournal.org/journal/view.html?doi=10.5056/jnm18048

  We present the case of a 63-year-old patient, with a long history of recurrent regurgitation of undigested food that occurred about 15 minutes after eating and could last for hours. […] Consequently, we concluded the diagnosis of rumination syndrome, proposing biofeedback treatment. […] The diagnosis of rumination syndrome in adults is based on the Rome IV criterion. […] A careful clinical history is very important in the diagnosis and in many cases is enough to establish it. […] However, in cases where there are diagnostic doubts, HRM and HRIM with a solid meal allow us to clarify the diagnosis. […] Pharmacological treatment is not very useful in rumination syndrome. […] Proton pump inhibitors and prokinetics are both ineffective. […] The usefulness of baclofen in this context has recently been demonstrated. […] However, the treatment that nowadays appears to obtained better short-term results is aimed at modifying the final mechanism that produces it by re-education of abdominal contractions and diaphragmatic breathing with biofeedback.

• #42 AGA Clinical Practice Update: Diagnosis of rumination syndrome | MDedge

  https://www.mdedge.com/gihepnews/article/173974/gastroenterology/aga-clinical-practice-update-diagnosis-rumination-syndrome

  Current limitations in the diagnosis of rumination syndrome include need for expertise and lack of standardized protocols, but “testing for rumination syndrome with postprandial high-resolution esophageal impedance manometry can be used to support the diagnosis.” […] Bacloflen (10 mg) taken three times daily is a “reasonable next step” for patients who do not respond to treatment.

• #43 Rumination syndrome: pathophysiology, diagnosis and practical management | Frontline Gastroenterology

  https://fg.bmj.com/content/13/5/440

  The two interventions most often used are diaphragmatic breathing and biofeedback. […] When the response to diaphragmatic breathing is incomplete, more advanced behavioural therapy with biofeedback may be an effective tool for rumination syndrome. […] There are very few studies on effective medical therapy for rumination syndrome. Baclofen may however be a reasonable option as second-line management option following behavioural approaches. […] Limited evidence from case series suggests that in refractory cases, rumination syndrome can be treated with Nissens fundoplication in order to enhance the resting pressure of the LOS and to partially negate the intragastric propulsive force provided by contraction of anterior wall musculature by reducing concurrent LOS relaxation. […] Rumination syndrome is a poorly recognised, infrequently diagnosed, yet easily manageable disorder of gut-brain interaction. Greater awareness among medical professionals will ensure prompt diagnosis, prevent malnutrition and reduce inappropriate referrals for psychiatric assessments or invasive investigations.

• #44 Diagnosis and Treatment of Rumination Syndrome: A Critical Review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6492032/

  Given current evidence, we recommend diaphragmatic breathing as the first-line strategy for RS treatment. […] We recommend clinicians use baclofen only with patients who have not achieved a substantial reduction in regurgitation frequency after behavioral intervention. […] Given current evidence, we recommend clinicians do not use surgical approaches, which aligns with previous conclusions in the literature.

• #45 Rumination Syndrome: An Update on Diagnostic and Treatment Strategies – Practical Gastro

  https://practicalgastro.com/2016/09/02/rumination-syndrome-an-update-on-diagnostic-and-treatment-strategies/

  Rumination can be a primary or a secondary disorder associated with states of chronic nausea and vomiting, such as gastroparesis. […] In both types of rumination syndrome, there is accompanying heartburn, due to refluxed material contacting the esophageal mucosa during the regurgitation event, and PPIs may be beneficial. […] While the diagnosis of rumination syndrome relies on thorough history and physical, invasive testing at a tertiary care facility may assist in eliminating the uncertainty regarding the diagnosis or unwillingness by the patient and/or the family to accept this diagnosis. […] The mainstay of treatment in RS consists of behavioral therapy focusing on breathing and relaxation techniques. […] A multidisciplinary team consisting of the gastroenterologist, nutritionist and mental health specialist is recommended to manage rumination syndrome.

• #46 Rumination Syndrome: An Update on Diagnostic and Treatment Strategies – Practical Gastro

  https://practicalgastro.com/2016/09/02/rumination-syndrome-an-update-on-diagnostic-and-treatment-strategies/

  The focus of treatment is using breathing and relaxation techniques to distract patients as they attempt to eat small meals. […] Physicians should also recognize the subset of patients in whom a feeding jejunostomy tube is necessary to maintain nutrition and electrolyte balance while the patient masters the breathing and relaxation approaches.

• #47 Rumination syndrome: pathophysiology, diagnosis and practical management | Frontline Gastroenterology

  https://fg.bmj.com/content/13/5/440

  Invasive investigations are not usually required to establish the diagnosis of rumination syndrome. A comprehensive history to elicit the key clinical features is sufficient in the majority of cases. […] The gold standard investigation for rumination syndrome, in cases where a history is insufficient to make a firm diagnosis, is high-resolution oesophageal manometry (HROM) with concurrent impedance monitoring. […] Following a positive clinical diagnosis of rumination syndrome, one of the most crucial aspects of treatment is an effective doctor-patient interaction. […] These explanations can be reinforced by the provision of a patient information leaflet recently developed by Guts-UK. […] Behavioural interventions have the greatest evidence base for the treatment of rumination syndrome.

• #48 Rumination syndrome – UpToDate

  https://www.uptodate.com/contents/rumination-syndrome

  Rumination syndrome is frequently misdiagnosed as gastroesophageal reflux disease or vomiting, resulting in a delay in diagnosis. […] This topic will review the epidemiology, etiology, diagnosis, and management of rumination syndrome. […] Rumination syndrome can affect children and adults. […] In a study that surveyed 2163 children and adolescents, 110 (5 percent) fulfilled clinical criteria for rumination syndrome. […] The prevalence of rumination was 3.1 and 5.8 percent, respectively. […] Rumination syndrome has been associated with anxiety, depression, obsessive compulsive disorder, post-traumatic stress disorder, adjustment disorder, attention deficit-hyperactivity disorder, and constipation from a rectal evacuation disorder. […] The pathogenesis of rumination syndrome is unclear, but unperceived abdominal wall activation in the postprandial period appears to be a key pathogenetic feature. […] On postprandial esophageal high resolution impedance manometry, rumination follows gastric pressurizations exceeding 30 mmHg, which is associated with lower and upper esophageal relaxation at the time of gastric pressurization.

• #49 Diagnosis and Treatment of Rumination Syndrome: A Critical Review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6492032/

  Rumination syndrome (RS) is characterized by the repeated regurgitation of material during or soon after eating with the subsequent rechewing, reswallowing, or spitting out of the regurgitated material. Rumination syndrome is classified as both a Functional Gastroduodenal Disorder (by the Rome Foundations Functional Gastrointestinal Disorders: Disorders of Gut-Brain Interaction, 4th edition) and a Feeding and Eating Disorder (by the Diagnostic and Statistical Manual of Mental Disorders, 5th edition). […] Rumination syndrome is a disorder that is often inaccurately diagnosed or missed, resulting in patients experiencing protracted symptoms and not receiving treatment for long periods. There is a lack of clear consensus for RS diagnosis, mechanisms that maintain RS, and treatment. […] We suggest assessment strategies to facilitate accurate diagnosis, and provide a schematic for intervention options. Overall, we recommend clinicians recognize the heterogeneous features of RS when considering diagnosis, assess for RS symptoms by clinical history, and treat RS with targeted diaphragmatic breathing while using other methods as augmented intervention or alternative treatment.

• #50 Rumination syndrome: pathophysiology, diagnosis and practical management | Frontline Gastroenterology

  https://fg.bmj.com/content/13/5/440

  The two interventions most often used are diaphragmatic breathing and biofeedback. […] When the response to diaphragmatic breathing is incomplete, more advanced behavioural therapy with biofeedback may be an effective tool for rumination syndrome. […] There are very few studies on effective medical therapy for rumination syndrome. Baclofen may however be a reasonable option as second-line management option following behavioural approaches. […] Limited evidence from case series suggests that in refractory cases, rumination syndrome can be treated with Nissens fundoplication in order to enhance the resting pressure of the LOS and to partially negate the intragastric propulsive force provided by contraction of anterior wall musculature by reducing concurrent LOS relaxation. […] Rumination syndrome is a poorly recognised, infrequently diagnosed, yet easily manageable disorder of gut-brain interaction. Greater awareness among medical professionals will ensure prompt diagnosis, prevent malnutrition and reduce inappropriate referrals for psychiatric assessments or invasive investigations.

• #51 Rumination Disorder | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/131534

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