When symptoms are more than reflux

Area of Science:

• Gastroenterology
• Digestive Physiology

Background:

• Rumination syndrome (RS) presents with postprandial regurgitation, often leading to delayed diagnosis due to symptom overlap with GERD and achalasia.
• Standard anti-acid treatments are frequently ineffective for RS, necessitating advanced diagnostic approaches.

Purpose of the Study:

• To investigate the diagnostic utility of high-resolution impedance manometry (HRIM) in a patient with suspected rumination syndrome.
• To illustrate the characteristic findings of RS using HRIM and impedance-pH monitoring.

Main Methods:

• A case study involving a patient with chronic heartburn and regurgitation unresponsive to medical therapy.
• High-resolution impedance manometry (HRIM) with a solid meal challenge, following Chicago Protocol 4.0.
• 24-hour impedance-pH monitoring to assess postprandial reflux events.

Main Results:

• HRIM revealed findings consistent with rumination syndrome, including increased intragastric pressure and esophageal sphincter relaxation.
• Impedance-pH monitoring showed proximal reflux episodes coinciding with the postprandial period.
• Abdominophrenic biofeedback therapy led to clinical improvement.

Conclusions:

• Rumination syndrome requires specific diagnostic criteria and can be accurately identified using HRIM, especially when symptoms are atypical or unresponsive to standard treatments.
• While impedance-pH monitoring can show associated reflux, HRIM with solid meal is the gold standard for diagnosing RS.