THE RUMINATION SYNDROME - CLINICAL-FEATURES RATHER THAN MANOMETRIC DIAGNOSIS

Background/Aims: Rumination is infrequent in adults of normal mental: capacity. Upper gastrointestinal manometry reportedly confirms the dia gnosis. Clinical characteristics, treatment(s), and outcomes of these patients are unclear. Methods:We assessed 38 adults and adolescents wi th rumination between 1987 and 1994. Esophagogastroduodenal manometric recordings (n = 36; 3-hour fasting and 2-hour postprandially) were re viewed; follow-up information was obtained from mailed questionnaires. Results: Patients saw a mean of five physicians and had symptoms for a mean of 2.75 years before diagnosis. Features included daily, effort less regurgitation of undigested food starting within minutes of meals . Weight loss was substantial (mean, 29 lb) in 42% of patients. Sevent een percent of female patients had a history of bulimia. Manometry con firmed the clinical diagnosis in 33% but was otherwise normal in all. Of 16 patients who responded to our questionnaires of 29 with >6 month s of follow-up (average, 35 months), 12 reported subjective improve me nt. In 14, the behavior persists. Conclusions: The rumination syndrome is underdiagnosed. With typical clinical features, gastroduodenal man ometry seems unnecessary to confirm the diagnosis. Diagnosis and reass urance are important in management to avoid unnecessary tests and trea tments.