Publication Date

10-2023

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Abstract

Introduction: Rumination syndrome is a disorder of gut-brain interaction characterized by effortless repetitive postprandial regurgitation, reswallowing, and/or spitting.(1) This condition is caused by increased intragastric pressure due to abdominal muscle contractions, leading to the opening of the lower esophageal sphincter and the return of gastric content into the esophagus.(1) Rumination is a clinical diagnosis after the exclusion of other etiologies of symptoms. The diagnosis of rumination is clinical, but supportive evidence can be obtained through esophageal or antroduodenal manometry.(2) We present a unique case report of rumination syndrome diagnosis supported by data obtained during colon manometry in a pediatric patient. Case: We describe the case of a 13-year-old male with autistic spectrum disorder who presented with chronic constipation, fecal soiling, and poor response to standard laxative treatments. An anorectal and colon manometry was performed prior to an antegrade continence enema procedure. The anorectal manometry showed normal resting anal pressures and recto-anal inhibitory reflex but revealed dyssynergic defecation. During the colon manometry, normal contractions were observed in the proximal colon, but during the postprandial phase, a simultaneous increase in pressure ("r" waves) was detected across all sensors in the colon. (Figure 1) Coinciding with this increase in pressure, the patient was observed to regurgitate and rechew food without experiencing any pain or discomfort. The family reported that the patient had been exhibiting this behavior since early childhood. In addition to modifying the patient's bowel regimen, diaphragmatic breathing exercises were recommended to address the rumination syndrome. Discussion: 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. These pressure waves likely originate from skeletal abdominal muscle contractions rather than from the stomach or intestines. Conclusion: 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.

Disciplines

Gastroenterology | Pediatrics

Notes

Presented at the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) Annual Meeting; San Diego, CA; Oct 4-7, 2023.

Rumination Syndrome Diagnosis Supported by Colon Manometry in a Pediatric Patient

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