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Chronic vomiting in children: A prospective study reveals rumination syndrome is an important etiology that is
Rohan Malik1,2, Anshu Srivastava3, Surender K Yachha3
1Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226 014, India. dr.rohanmalik@gmail.com.
Insights
Rumination syndrome is often misdiagnosed in children, leading to unnecessary tests and treatments. Early clinical diagnosis and diaphragmatic breathing therapy can effectively manage this condition, with high success rates.
Area of Science:
- Pediatric Gastroenterology
- Functional Gastrointestinal Disorders
Background:
- Rumination syndrome is frequently overlooked in children, resulting in delayed diagnosis and inappropriate interventions.
- Children often undergo extensive testing and receive incorrect treatments for chronic vomiting attributed to other causes.
Purpose of the Study:
- To systematically explore rumination syndrome as a cause of chronic vomiting in Indian children.
- To highlight the diagnostic challenges and treatment outcomes for rumination syndrome.
Main Methods:
- A prospective study enrolled 50 children (5-18 years) with chronic vomiting (≥2 months duration).
- Clinical history was assessed using a physician-administered questionnaire and ROME III criteria.
- Standard and additional investigations were performed as needed.
Main Results:
- Rumination syndrome was the predominant diagnosis in 30 out of 50 children.
- Children with rumination syndrome experienced delayed diagnoses (87% incorrect/no diagnosis) and received multiple treatments, including surgery.
- Diaphragmatic breathing therapy led to resolution in 87% of cases, with a 27% relapse rate.
Conclusions:
- The diagnosis of rumination syndrome is often significantly delayed, leading to inappropriate medical care for affected children.
- Diaphragmatic breathing is an effective therapy for rumination syndrome, achieving high rates of symptom resolution.
Background:
The diagnosis of rumination syndrome is frequently overlooked, and under-recognized; children are subjected to unnecessary testing and inappropriate treatment for a condition which can be diagnosed clinically and managed easily. In the first ever systematic exploration of this condition from India, we present a prospective study on children with chronic vomiting in which rumination emerged as the predominant cause.
Methods:
This was a prospective study in which all consecutive children (5-18 years) presenting with chronic or recurrent vomiting of at least 2-month duration were enrolled. Clinical history was assessed by a physician-administered questionnaire. All subjects underwent standard testing followed by additional investigations as required. The ROME III criteria were used.
Results:
Fifty children (28 boys, age 12.2 + 3 years) were enrolled. Diagnosis was rumination syndrome 30, cyclical vomiting 8, functional vomiting 6, intestinal tuberculosis 4, intestinal malrotation 1, and superior mesenteric artery syndrome 1. Children with rumination syndrome had a relapsing and remitting (12, 40%) or a chronically symptomatic course (18, 60%). These children received incorrect diagnoses (26, 87%) or no diagnosis (3, 10%) and extensive investigation before referral. Before referral, children with rumination syndrome were treated with a median of four drugs (range 1 to 9); two underwent surgery (appendectomy) for their symptoms while one child was subjected to electroconvulsive therapy. Overall, resolution after treatment was seen in 26 (87%) with a relapse in 8 (27%) children.
Conclusion:
The diagnosis of rumination syndrome is delayed and these children are often inappropriately treated. Therapy in the form of diaphragmatic breathing has a good success rate.
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