Role of Gastric Motor Abnormalities in Pathophysiology of Rumination Syndrome in Children

The pathophysiology of rumination syndrome is not entirely elucidated. We aimed to assess gastric emptying and fundic accommodation through solid gastric emptying scintigraphy in children with rumination syndrome and explore the relationship between scintigraphic findings and high-resolution impedance esophageal manometry results.

Gastric retention at 1, 2, 3, and 4 h from standardized meal ingestion were measured. Delayed gastric emptying was defined as gastric retention > 10% at 4 h. The ratio of gastric counts in the proximal stomach to those in the entire stomach measured immediately after meal ingestion (IMD⁰) was used as a marker of fundic accommodation. A value of < 0.568 defined an impaired fundic accommodation. The number of rumination episodes occurring during the first postprandial hour of manometry recording were calculated.

Among 33 children included (median age: 14 years) 10 (30%) had impaired fundic accommodation and 12 (36%) delayed gastric emptying. Children with impaired fundic accommodation have a higher median number of rumination events [10 (IQR 7-12) vs. 6 (IQR 4-89); p = 0.03] recorded during the first postprandial hour. Similarly, at 1-h children with delayed gastric emptying have a higher median number of rumination events [12 (IQR 10-13) vs. 6 (IQR 3-8); p = 0.0004]. The number of rumination events was inversely related to IMD⁰ (p = 0.03; r = -0.4) and directly related to gastric retention at 1-h in the whole stomach (p = 0.003; r = 0.5), fundus (p = 0.03; r = 0.4) and antrum (p = 0.02; r = 0.4).

More than half of children with rumination syndrome included in our study present an abnormal gastric motor function on solid-meal gastric emptying scintigraphy that might contribute to the occurrence of rumination episodes. The detection of these abnormalities might enhance targeted clinical trials and patient management.