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Early childhood-onset rumination syndrome is clinically distinct from adolescent-onset rumination syndrome

Dennis M Yang1,2, Julia Sabella1,2, Ashley Kroon Van Diest3

  • 1Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, Nationwide Children's Hospital, Columbus, Ohio, USA.

Journal of Pediatric Gastroenterology and Nutrition
|March 20, 2024
PubMed

Insights

Early-onset rumination syndrome (RS) in children presents differently than adolescent-onset RS, with distinct sex distributions and comorbidities. Early-onset RS shows a different clinical course and may have a unique pathogenesis.

Area of Science:

  • Pediatric Gastroenterology
  • Child Psychology
  • Clinical Epidemiology

Background:

  • Rumination syndrome (RS) in early childhood is understudied and difficult to manage.
  • Understanding the differences between early-onset (EO) and adolescent-onset (AO) RS is crucial for effective treatment.
  • This study aims to delineate the distinct characteristics and outcomes of these two patient groups.

Purpose of the Study:

  • To compare the clinical characteristics, severity, and treatment outcomes of early-onset (EO) versus adolescent-onset (AO) rumination syndrome (RS) in children.
  • To identify potential differences in pathogenesis and natural history between EO and AO RS.

Main Methods:

  • An ambidirectional cohort study was conducted.
  • Patients were categorized into EO (symptom onset ≤5 years, diagnosis ≤12 years) and AO (onset >12 years) groups.
  • Demographics, clinical features, severity indicators, and outcomes were compared between the two groups.

Main Results:

  • 49 EO and 52 AO RS patients were analyzed.
  • EO RS showed a male predominance, while AO RS was predominantly female (p=0.016).
  • EO patients had higher rates of developmental delay (24% vs. 8%) and lower rates of depression (0% vs. 23%) and anxiety (14% vs. 40%) compared to AO patients.
  • EO RS presented with greater regurgitation frequency but lower vomiting frequency, leading to less meal skipping, reduced need for tube feeding, and less weight loss compared to AO RS.
  • EO RS symptoms significantly improved over time, with reduced regurgitation and vomiting frequencies at follow-up.

Conclusions:

  • Early-onset rumination syndrome is clinically distinct from adolescent-onset RS.
  • Differences are observed in sex distribution, comorbid conditions (developmental delay, depression, anxiety), and initial presentation severity.
  • The distinct clinical profiles suggest potentially different underlying pathogenesis and natural history for EO and AO RS.
Abstract

Keywords:
disorders of gut-brain interactionfunctional GI disordersnauseavomiting

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