Long-term Follow-up of Adolescents Treated for Rumination Syndrome in an Inpatient Setting.

OBJECTIVES: Although several studies have demonstrated the short-term benefit of the behavioral treatment of rumination syndrome, few have investigated the long-term outcomes. Studies reporting long-term benefit have involved combined pediatric and adult samples or have examined outcomes of patients involved in various types of treatment. The purpose of the present study was to examine several aspects of long-term outcome in adolescent patients who took part in the same intensive, interdisciplinary, inpatient behavioral treatment approach. METHODS: Self-report measures were completed by 47 adolescent patients (mean age = 15.9) around 1 year or more from discharge from our inpatient program. Measures indexed changes in rumination, medical outcomes (eg, use of supplemental nutrition), somatic symptoms, and quality of life. RESULTS: Most patients reported continued improvement in their rumination over time, with 20% reporting cessation of rumination for at least 6 months. The majority of patients no longer required supplemental nutrition and reported improvements in somatic symptoms and quality of life. Patients who reported greater improvement in rumination also reported more significant improvements in their somatic symptoms and quality of life. CONCLUSIONS: Intensive behavioral treatment of rumination syndrome leads to long-term improvement in rumination as well as other related factors, including somatic symptoms and quality of life.

High Cost and Low Yield: The Diagnostic Evaluation of Rumination Syndrome in Pediatrics.

OBJECTIVE: To document the use of diagnostic testing in adolescents who ultimately were diagnosed with rumination syndrome, a functional gastrointestinal disorder. We examined the diagnostic yield of each test as well as the associated costs, and we determined if any demographic or illness-related variables impacted the magnitude of the work-up. STUDY DESIGN: A retrospective chart review was conducted for 68 patients with rumination syndrome admitted to our inpatient treatment program. The cost and findings of patients' diagnostic investigations were gathered, as well as demographic and illness-related variables to determine factors that may be related to evaluation size. RESULTS: The most commonly used tests in the evaluation of rumination syndrome included esophagogastroduodenoscopy, gastric emptying, antroduodenal manometry, upper gastrointestinal series, and abdominal ultrasound scan. Each patient underwent an average of 8.8 tests, with the average cost for each patient's diagnostic work-up being US $19 795. Few tests were found to be beneficial in the diagnosis of rumination syndrome, and few demographic or illness variables were found to be related to the overall extent of the investigation. CONCLUSIONS: Extensive testing for rumination syndrome in adolescents is common in clinical practice, and comes at a high financial cost with low yield, likely delaying diagnosis and treatment. Symptom-based criteria should be used to make the diagnosis of rumination syndrome.

Adolescent rumination syndrome.

Rumination syndrome is the non-purposeful regurgitation of recently ingested food from the stomach to the mouth, where it is either expelled or reswallowed. Adolescent rumination syndrome (ARS) is a rare condition of which many physicians are unaware. Patients often are misdiagnosed or undergo costly testing, and as a result, diagnosis and treatment are often delayed. While ARS is not life-threatening, it does have medical and emotional effects on the patient and the patient's family. Diagnosis of ARS is based upon the Rome III diagnostic criteria. Antroduodenal manometry, while not required for a diagnosis, can be helpful to confirm the diagnosis. The pathogenesis of this disorder is complex and not well understood. However, because of its behavioral component, treatment of ARS requires a multidisciplinary approach that includes both medical management of symptoms and implementation of strategies that address behavioral, psychological, and general quality-of-life components of the disorder.

Adolescent rumination syndrome.

Adolescent Rumination Syndrome (ARS) is a relatively uncommon disorder, defined by the involuntary regurgitation of recently ingested food from the stomach to the mouth, where it is either expelled or re-swallowed. Although the disorder itself is not life-threatening, it typically has a significant medical and psychosocial impact on the patient and family. There continues to be limited awareness about the clinical presentation, diagnosis, and treatment of ARS among clinicians. As such, adolescents presenting with symptoms of ARS often are misdiagnosed and typically undergo avoidable, extensive, invasive, and costly testing. This article seeks to increase awareness and knowledge about ARS, and to provide the clinician with practical guidelines regarding the pathogenesis, assessment, diagnosis, and treatment of ARS.

Severe pediatric rumination syndrome: successful interdisciplinary inpatient management.

BACKGROUND: Rumination syndrome is a condition that occurs when people constantly regurgitate and expel or reswallow food soon after they eat. The most severe cases of rumination syndrome can be debilitating, requiring total parenteral nutrition or enteral tube feedings. We report our experience with the treatment of children with severe rumination syndrome. PATIENTS AND METHODS: Five patients with severe rumination syndrome received a novel inpatient interdisciplinary approach, which involved pediatric psychology, pediatric gastroenterology, clinical nutrition, child life, therapeutic recreation, and massage therapy. RESULTS: Inpatient hospitalization lasted between 9 and 13 days. The treatment was successful in all 5 of the patients. They left with complete caloric intake orally. CONCLUSIONS: This treatment protocol could benefit pediatric gastroenterologists, pediatricians, and child psychologists in managing both standard and severe cases of rumination syndrome.