Rumination syndrome in adolescents

Objectives: To evaluate the clinical presentation and to assess the usefuln ess of antroduodenal manometry (ADM) and the results of multidisciplinary t eam management in 12 neurologically normal adolescents (9 girls) with rumin ation Study design: All patients had extensive investigations that ruled out othe r causes of their chronic symptoms. We performed ADM in all patients. A mul tidisciplinary approach was used for the nutritional and behavioral rehabil itation of these patients. Results: The median age at presentation was 14 years (range, 9-19 years), a nd the average duration of symptoms was 17 months. All patients complained of postprandial, effortless regurgitation, and the majority had weight loss and abdominal pain. Results of fasting ADM were normal in all. The postpra ndial ADR showed brief, simultaneous pressure increases at all recording si tes, associated with regurgitation in 8 patients. No emesis was observed in the other 4 children during the study. Treatment included nutritional supp ort in combination with antidepressants and anxiolytics (n = 6), cognitive therapy with biofeedback or relaxation techniques (n = 7), and pain managem ent (n = 2). Resolution or improvement of symptoms was seen in 10 of the 12 patients, and successful transition to oral feedings was achieved in all d uring the follow-up period, which ranged from 5 to 36 months, Conclusions: Rumination is a distinct functional gastrointestinal disorder of otherwise healthy children and adolescents, which can be diagnosed on th e basis of clinical features. The ADM shows a characteristic pattern and ru les out mobility disorders that are often confused with rumination. A multi disciplinary team approach is associated with satisfactory recovery in most patients.