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Updated: Dec 28, 2025
Simultaneous Laryngopharyngeal and Conventional Esophageal pH Monitoring
Published on: December 14, 2020
Rumination Syndrome in Children Presenting With Refractory Gastroesophageal Reflux Symptoms
Kornilia Nikaki1,2, Anna Rybak3, Kenichiro Nakagawa1
1Wingate Institute of Neurogastroenterology, Blizard Institute, Barts and The London School of Medicine and Dentistry, QMUL.
Insights
A distinct impedance-pH monitoring pattern helps identify rumination syndrome in children with refractory GERD. This scoring system aids in early diagnosis, differentiating it from standard GERD management.
Area of Science:
- Pediatric Gastroenterology
- Diagnostic Tools
- Reflux Disorders
Background:
- Refractory GERD affects many children unresponsive to standard treatments.
- Rumination syndrome is a differential diagnosis in refractory GERD, with distinct management strategies.
- Accurate identification of rumination syndrome is crucial for effective pediatric care.
Purpose of the Study:
- To identify specific impedance-pH monitoring patterns indicative of rumination syndrome in children with persistent GERD symptoms.
- To develop and validate a scoring system for distinguishing rumination syndrome from GERD and other conditions.
- To improve diagnostic accuracy for rumination syndrome in pediatric refractory GERD.
Main Methods:
- Compared impedance-pH monitoring parameters across four groups: rumination syndrome, GERD, non-GERD, and negative for rumination.
- Utilized high-resolution manometry impedance (HRM/Z) for rumination syndrome diagnosis.
- Developed a scoring system based on identified parameters and validated its sensitivity and specificity in a separate cohort.
Main Results:
- Rumination syndrome was identified in 44% of children with refractory GERD.
- Key indicators include numerous proximal reflux episodes, frequent postprandial nonacid reflux, and high symptom-reflux association (SAP).
- A scoring system achieved 75% sensitivity and 80% specificity in identifying rumination syndrome.
Conclusions:
- Children with rumination syndrome exhibit a unique impedance-pH monitoring profile.
- A simple scoring system applied to impedance-pH analysis can facilitate early diagnosis of rumination syndrome.
- Distinguishing rumination syndrome in pediatric refractory GERD is achievable through specific diagnostic patterns.
Objectives:
Up to 40% of children presenting with reflux symptoms do not respond to standard medical interventions. In adults, 20% of patients presenting with Proton Pump Inhibitors refractory Gastro-Esophageal Reflux Disease (GERD) have rumination syndrome. The management of GERD and rumination differ significantly. Our study aimed to identify rumination syndrome amongst children presenting with persistent GERD symptoms based on a distinct pattern on impedance-pH monitoring.
Methods:
The parameters of impedance-pH monitoring were compared between children with rumination syndrome (n = 12), diagnosed on high-resolution manometry impedance (HRM/Z), children with GERD (n = 18), children with an alternative diagnosis (non-GERD, n = 12) and children negative for rumination based on HRM/Z (n = 14). The parameters that distinguish the rumination group were identified and incorporated into a scoring system, which was blindly applied on a separate group of children with refractory GERD (n = 18) to define its sensitivity and specificity.
Results:
Rumination syndrome presents in 44% of children with refractory GERD. Children with rumination syndrome present with a large number of proximal reflux episodes (>57.5 episodes/24 hours); a high frequency of nonacid reflux events in the postprandial period (>2/hour); and a highly positive symptom-reflux association analysis (SAP ≥ 95%). A score of ≥2 out of the 3 points distinguishes children with rumination syndrome with 75% sensitivity and 80% specificity.
Conclusions:
Children with rumination syndrome have a distinct pattern of impedance-pH monitoring and can be distinguished amongst children presenting with refractory GERD. Applying a simple scoring system during impedance-pH analysis could lead to early diagnosis of children with rumination syndrome.
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