Objectives. To characterize the clinical features, results of diagnostic testing, and treatment outcomes for children and adolescents with rumination syndrome.
Methods. Review of the medical records for all 147 patients ages 5 to 20 diagnosed with rumination syndrome at our institution between 1975 and 2000. Data are presented as mean ± the standard error of the mean.
Results. Sixty-eight percent were female. Age at diagnosis was 15.0 ± 0.3 years. Symptom duration before diagnosis was 2.2 ± 0.3 years, 73% missed school/work, and 46% had been hospitalized because of symptoms. Before diagnosis, 16 (11%) underwent surgery for evaluation or management of symptoms. Twenty-four (16%) had psychiatric disorders; 3.4% had anorexia or bulimia nervosa. All patients described postprandial regurgitation after almost every meal (2.7 ± 0.1 meals per day). Weight loss was described by 42.2% (median: 7 kg). Additional symptoms included: abdominal pain, 38%; constipation, 21%; nausea, 17%; and diarrhea, 8%. Structural studies were normal. Gastric emptying of solids at 4 hours was delayed in 26 of 56 patients. Esophageal pH testing in 24 patients showed reflux/regurgitation in 54%. Gastroduodenal manometry in 65 patients showed characteristic rumination-waves in 40%. Outcome data (at median follow-up 10 months) were available for 54 patients. Symptoms resolved in 16 (30%) and improved in 30 (56%).
Conclusions. Recognition of the clinical features of rumination syndrome in children and adolescents is essential; the diagnosis is often delayed and associated with morbidity. Extensive diagnostic testing is unnecessary. Early behavioral therapy is advocated, and patient outcomes are generally favorable.
Comments
Rebuttle to some "facts"
Hello I would like to start by thanking the doctors who made this paper. In a world driven by money and pharmaceutical companies that control the direction of medical science, its nice to see some doctors care about diseases that can't be temporarily fixed with expensive band-aids (medication).
My significant other suffered from rumination for four and a half years. Every doctor told her that she was doing it, was bulimic, or was crazy. It was rather upsetting to know that this was no different in Rochester, where the doctors (Except the GI doctor, the ONLY doctor that needed to see her) made every attempt to convince her that it wasn't rumination. She was diagnosed and taught to breathe. Ironic that the thing she had done all her life was the cure. Upsetting that the doctors couldn't simply ask her to eat something in front of them and immediately diagnose her, no questions asked.
There is something in this paper that truly bothers me. It especially bothers me because doctors that read this will continue to walk around blind to the reality of the situation. You have cited a paper from 1958 that has declared rumination a "benign" disorder. I only can hope that this refers to it not being cancerous (In which case I ask that you specify that in the paper). However, I am more inclined to assume that this means that doctors believe this disorder to be a mere inconvenience.
I do not know who the doctors are speaking for. The patients, or themselves. I can only say that those doctors should go hungry for 4 years no matter how much they eat, and then be told that they are "eating too much". Those doctors should try living 2.75 years (The average time before diagnosis) without keeping down a single meal. When this happens, you may call this disorder benign. Until then, this is a serious condition and should be treated as such. Please remove the benign statement from your papers and do not cite a journal from 1958 that studied a handful of patients.
- Justin O'Neill
Conflict of Interest:
A member of my family suffered from rumination for 4 years. After a week of unnecessary and expensive testing at Mayo Clinic Rochester, she was diagnosed and showing the breathing exercises. Her rumination ceased immediately.