Herit Vachhani1, Bruno De Souza Ribeiro2, Ron Schey3,4. 1. Division of Gastroenterology, Department of Medicine, University of Florida College of Medicine-Jacksonville, Jacksonville, FL, USA. 2. Neurogastroenterology & Esophageal Program, University of Florida College of Medicine-Jacksonville, Building 1, Suite 300, 4555 Emerson Street, Jacksonville, FL, 32207, USA. 3. Division of Gastroenterology, Department of Medicine, University of Florida College of Medicine-Jacksonville, Jacksonville, FL, USA. ron.schey@jax.ufl.edu. 4. Neurogastroenterology & Esophageal Program, University of Florida College of Medicine-Jacksonville, Building 1, Suite 300, 4555 Emerson Street, Jacksonville, FL, 32207, USA. ron.schey@jax.ufl.edu.
Abstract
PURPOSE OF REVIEW: The purpose of this paper is to discuss current diagnostic and treatments of rumination. Rumination is often underdiagnosed or misdiagnosed in adults, especially when symptoms suggest regurgitation rather than vomiting accompanied by re-chewing and re-swallowing and should be included in the differential diagnosis. It is primarily diagnosed clinically by ROME-IV or DSM-5. RECENT FINDINGS: That rumination can be re-affirmed by characteristic patterns on objective testing such as high-resolution esophageal manometry and 24-h pH impedance testing. However, although gastroduodenal manometry and EMG are helpful, these tests are slowly losing interest given their technical nature of data gathering, time consumption, cost burden, and patient discomfort. Rumination is primarily diagnosed clinically by ROME-IV or DSM-5 in addition to high-resolution esophageal manometry and 24-h pH impedance. Management is challenging and usually a combination of behavioral, pharmacological, and rarely surgical treatment. Recent data demonstrate that the combination of behavioral techniques such as diaphragmatic breathing exercises and/or with baclofen has promising results. Further research is necessary to further define objective criteria for diagnosis and other therapeutic modalities for treatment.
PURPOSE OF REVIEW: The purpose of this paper is to discuss current diagnostic and treatments of rumination. Rumination is often underdiagnosed or misdiagnosed in adults, especially when symptoms suggest regurgitation rather than vomiting accompanied by re-chewing and re-swallowing and should be included in the differential diagnosis. It is primarily diagnosed clinically by ROME-IV or DSM-5. RECENT FINDINGS: That rumination can be re-affirmed by characteristic patterns on objective testing such as high-resolution esophageal manometry and 24-h pH impedance testing. However, although gastroduodenal manometry and EMG are helpful, these tests are slowly losing interest given their technical nature of data gathering, time consumption, cost burden, and patient discomfort. Rumination is primarily diagnosed clinically by ROME-IV or DSM-5 in addition to high-resolution esophageal manometry and 24-h pH impedance. Management is challenging and usually a combination of behavioral, pharmacological, and rarely surgical treatment. Recent data demonstrate that the combination of behavioral techniques such as diaphragmatic breathing exercises and/or with baclofen has promising results. Further research is necessary to further define objective criteria for diagnosis and other therapeutic modalities for treatment.
Authors: Priya Vijayvargiya; Johanna Iturrino; Michael Camilleri; Andrea Shin; Maria Vazquez-Roque; David A Katzka; Jill R Snuggerud; Richard J Seime Journal: United European Gastroenterol J Date: 2014-02-01 Impact factor: 4.623