Rumination syndrome in children and adolescents: diagnosis, treatment, and prognosis

Pediatrics. 2003 Jan;111(1):158-62. doi: 10.1542/peds.111.1.158.

Abstract

Objectives: To characterize the clinical features, results of diagnostic testing, and treatment outcomes for children and adolescents with rumination syndrome.

Methods: Review of the medical records for all 147 patients ages 5 to 20 diagnosed with rumination syndrome at our institution between 1975 and 2000. Data are presented as mean +/- the standard error of the mean.

Results: Sixty-eight percent were female. Age at diagnosis was 15.0 +/- 0.3 years. Symptom duration before diagnosis was 2.2 +/- 0.3 years, 73% missed school/work, and 46% had been hospitalized because of symptoms. Before diagnosis, 16 (11%) underwent surgery for evaluation or management of symptoms. Twenty-four (16%) had psychiatric disorders; 3.4% had anorexia or bulimia nervosa. All patients described postprandial regurgitation after almost every meal (2.7 +/- 0.1 meals per day). Weight loss was described by 42.2% (median: 7 kg). Additional symptoms included: abdominal pain, 38%; constipation, 21%; nausea, 17%; and diarrhea, 8%. Structural studies were normal. Gastric emptying of solids at 4 hours was delayed in 26 of 56 patients. Esophageal pH testing in 24 patients showed reflux/regurgitation in 54%. Gastroduodenal manometry in 65 patients showed characteristic rumination-waves in 40%. Outcome data (at median follow-up 10 months) were available for 54 patients. Symptoms resolved in 16 (30%) and improved in 30 (56%).

Conclusions: Recognition of the clinical features of rumination syndrome in children and adolescents is essential; the diagnosis is often delayed and associated with morbidity. Extensive diagnostic testing is unnecessary. Early behavioral therapy is advocated, and patient outcomes are generally favorable.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adolescent
  • Adult
  • Age of Onset
  • Anorexia / epidemiology
  • Bulimia / epidemiology
  • Child
  • Child, Preschool
  • Comorbidity
  • Feeding and Eating Disorders of Childhood / diagnosis*
  • Feeding and Eating Disorders of Childhood / epidemiology*
  • Feeding and Eating Disorders of Childhood / therapy
  • Female
  • Hospitalization / statistics & numerical data
  • Humans
  • Male
  • Medical History Taking
  • Mental Disorders / epidemiology
  • Minnesota / epidemiology
  • Prognosis
  • Sex Distribution
  • Syndrome
  • Treatment Outcome