Detection and characteristics of rumination syndrome in patients presenting for gastric symptom evaluation. Issue 8 (17th March 2021)

• Record Type: Journal Article
• Authors: Murray, Helen Burton; Pasricha, Trisha S.; Jehangir, Asad; Thomas, Jennifer J.; Kuo, Braden; Parkman, Henry P.
• Is Part Of: Neurogastroenterology & motility. Volume 33:Issue 8(2021)
• Page Start: n/a
• Page End: n/a
• Publication Date: 2021-03-17
• Subjects: disorders of gut‐brain interaction -- functional gastrointestinal disorder -- gastroparesis -- rumination disorder -- rumination syndrome; Gastrointestinal system -- Motility -- Periodicals; Gastrointestinal system -- Innervation -- Periodicals; 616.33
• DOI: 10.1111/nmo.14103
• Languages: English
• ISSNs: 1350-1925

Abstract

Abstract: Background: Rumination syndrome involves effortless, repeated regurgitation, and can overlap with other upper gastrointestinal disorders, including gastroparesis. To inform better diagnostic detection of rumination, we aimed to (1) identify frequency and characteristics of rumination in patients presenting for gastric symptom evaluation; and (2) assess demographic and clinical characteristics that could differentiate those with versus those without rumination. Methods: Consecutively referred patients to two tertiary academic centers for gastric symptom specialty evaluation were included ( N = 242). We obtained demographic information, gastric emptying scintigraphy, upper gastrointestinal symptoms using the Patient Assessment of Upper Gastrointestinal Symptoms (PAGI‐SYM), and Rome IV‐based rumination questionnaire. Key Results: Thirty‐one of the 242 (12.8%) patients met criteria for rumination syndrome, of which 48% reported associated psychosocial impairment. Comparing those with rumination and those without, there were no differences in race, gender, frequency of diabetes, or frequency of gastroparesis. The median PAGI‐SYM score for rumination patients was higher than for those without (3.03 vs. 2.55; unadjusted p = 0.043, adjusted p = 0.30). This was largely driven by increased heartburn/regurgitation subscale scores (2.71 vs. 1.57, unadjusted p = 0.0067, adjusted p = 0.046), itself influenced by elevated daytime regurgitation/reflux (3.0 vs. 2.0; unadjusted p = 0.007, adjusted p = 0.048). There were no significant differences on the remaining PAGI‐SYM subscales. Conclusions and Inferences: Rumination syndrome determined by Rome IV criteria was present in 12.8% of patients presenting for gastric symptom evaluation. Higher self‐report PAGI‐SYM heartburn/regurgitation subscale scores, particularly daytime regurgitation/reflux symptoms, were the only parameters that distinguished rumination. The PAGI‐SYM heartburn/regurgitation subscale could be used to screen for rumination, in addition to GERDAQ6. Abstract : Rumination syndrome involves effortless, repeated regurgitation, and can overlap with other upper gastrointestinal disorders, including gastroparesis. Among 242 patients presenting for gastric symptom evaluation, 12.8% met criteria for rumination syndrome with 48% reporting significant psychosocial impairment. Patients with rumination had higher Patient Assessment of Upper Gastrointestinal Symptoms scores than those without rumination, driven by increased heartburn/regurgitation subscale scores.