The rumination syndrome: clinical features rather than manometric diagnosis

Abstract

Background/aims: Rumination is infrequent in adults of normal mental capacity. Upper gastrointestinal manometry reportedly confirms the diagnosis. Clinical characteristics, treatment(s), and outcomes of these patients are unclear.

Methods: We assessed 38 adults and adolescents with rumination between 1987 and 1994. Esophagogastroduodenal manometric recordings (n = 36; 3-hour fasting and 2-hour postprandially) were reviewed; follow-up information was obtained from mailed questionnaires.

Results: Patients saw a mean of five physicians and had symptoms for a mean of 2.75 years before diagnosis. Features included daily, effortless regurgitation of undigested food starting within minutes of meals. Weight loss was substantial (mean, 29 lb) in 42% of patients. Seventeen percent of female patients had a history of bulimia. Manometry confirmed the clinical diagnosis in 33% but was otherwise normal in all. Of 16 patients who responded to our questionnaires of 29 with > 6 months of follow-up (average, 35 months), 12 reported subjective improvement. In 14, the behavior persists.

Conclusions: The rumination syndrome is underdiagnosed. With typical clinical features, gastroduodenal manometry seems unnecessary to confirm the diagnosis. Diagnosis and reassurance are important in management to avoid unnecessary tests and treatments.