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Published on: December 14, 2020
High-resolution Esophageal Manometry Patterns in Children and Adolescents With Rumination Syndrome
Franziska Righini Grunder1,2, Ann Aspirot2, Christophe Faure1,2
1Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics.
Insights
High-resolution esophageal manometry (HREM) confirms rumination syndrome in children by detecting objective regurgitation episodes. This diagnostic tool differentiates primary from secondary rumination, aiding clinical management.
Area of Science:
- Pediatric Gastroenterology
- Gastrointestinal Motility Disorders
Background:
- Rumination syndrome is characterized by effortless regurgitation of recently ingested food.
- Accurate diagnosis is crucial for effective management in pediatric patients.
Purpose of the Study:
- To identify the high-resolution esophageal manometry (HREM) pattern in children diagnosed with rumination syndrome.
- To assess HREM's utility in differentiating between primary and secondary rumination.
Main Methods:
- High-resolution esophageal manometry (HREM) was performed on 15 pediatric patients with rumination syndrome and 15 age-matched controls.
- Rumination episodes were defined by specific criteria, including gastric pressure changes and transient lower esophageal sphincter relaxations (TLESRs).
Main Results:
- HREM detected 92 rumination episodes in 12 of 15 patients (80%), with a median intragastric pressure of 49.6 mmHg.
- Primary rumination was observed in 3 patients, secondary rumination in 5, and mixed in 1. HREM showed 80% sensitivity and 100% specificity for diagnosing rumination.
- No rumination episodes were recorded in the control group.
Conclusions:
- High-resolution esophageal manometry (HREM) effectively confirms the diagnosis of rumination syndrome in children.
- HREM provides objective evidence to differentiate between primary and secondary rumination, potentially guiding treatment strategies.
Background:
Rumination is defined by effortless regurgitation within seconds or minutes of ingested food. The aim of this study was to determine the high-resolution esophageal manometry (HREM) pattern in children with rumination syndrome.
Methods:
HREM was evaluated in 15 pediatric patients with rumination syndrome according to the Rome criteria and compared with 15 controls. Primary rumination was defined as a clinical rumination episode associated with a rise of gastric pressure above 30 mmHg. Secondary rumination was defined as a clinical rumination episode associated with a rise of gastric pressure above 30 mmHg during a transient lower esophageal sphincter relaxation (TLESR).
Results:
Ninety-two episodes of rumination were demonstrated during HREM study in 12 of the 15 patients (80%; 1-29 episodes per patient; median intragastric pressure 49.6 mmHg). Primary rumination occurred in 3 patients and secondary rumination in 5 patients. One patient had primary and secondary rumination episodes. In 3 patients, classification of rumination episodes was not possible due to repetitive swallowing leading to lower esophageal sphincter relaxation. In the control group, no episodes of rumination occurred. The sensitivity and the specificity of the HREM study (association of a clinical rumination episode with a rise in gastric pressure >30 mmHg) to confirm the diagnosis of rumination were 80% and 100%, respectively.
Conclusions:
HREM allows confirming diagnosis of rumination syndrome and to differentiate between primary and secondary rumination in the presence of objective rumination episodes. Further research is needed to study whether HREM results may influence treatment and outcome of children with rumination syndrome.
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