Impact of diagnostic testing on outcomes of children with rumination syndrome

Rumination syndrome (RS) is diagnosed based on clinical criteria with or without diagnostic testing showing characteristic findings on antroduodenal manometry (ADM), high-resolution esophageal manometry (HREM), and multichannel intraluminal impedance-pH testing (MII-pH). The objective of this study was to evaluate the correlation between diagnostic testing and clinical outcomes.

We conducted a retrospective review of children with RS evaluated at our institution. Patients were divided into two groups: those with confirmatory diagnostic testing for rumination based on ADM, HREM, and/or MII-pH, and those without. We compared response to treatment based on the proportion no longer having vomiting at follow-up and no longer needing supplemental nutrition.

We included 152 children (60% female, median age of diagnosis 13 years, interquartile range 8-15 years) with RS. 22 patients (14%) had diagnostic testing that confirmed RS. At baseline, there was no statistical difference in the percentage of patients who had overt vomiting (p = 0.311), however, the confirmatory testing group was more likely to need supplemental nutrition (p ≤ 0.001) and to receive intensive treatment (p < 0.001). After treatment, the proportion of patients without vomiting increased in both groups without a statistically significant difference between the two groups. There were also no significant differences in likelihood of reporting improvement in symptoms or needing supplemental nutrition.

Children with RS who had confirmatory diagnostic testing were equally likely to no longer have vomiting after treatment when compared to those without confirmatory testing. Future studies are needed to account for potential differences in baseline severity between groups.