Potential value of using pH-impedance monitoring to evaluate for rumination syndrome in children

pH-impedance monitoring (pH-MII) is often used to evaluate severity and type of gastroesophageal reflux disease (GERD). The Nakagawa rumination score, which is derived using data from pH-MII, has been proposed as a metric to diagnose rumination syndrome in adults. However, this approach has not been validated in children. Esophageal manometry to diagnose rumination syndrome is not available in many centers. Our goal was to assess the utility of pH-MII as a substitute for manometry to diagnose rumination syndrome in children.

Pediatric patients who underwent pH-MII at the University of Iowa Children's Hospital between 2019 and 2025 were included. Demographic and clinical data, indications, pH-MII findings including Nakagawa rumination score if done, and patient outcome data for rumination syndrome were collected.

Ninety-seven pH-MII were completed on 94 children aged 23 days old to 19 years old (median 11 [interquartile range, (IQR) 5-15]). The most common indication identified (44%) was to "evaluate for reflux". Twelve of these children were further evaluated for rumination syndrome; 10 had a Nakagawa rumination score calculated, with 9 scoring as positive. Eleven children had pH-MII suggestive of rumination syndrome. Four responded to rumination therapy, two did not, two were too recent to assess, two were lost to follow-up, and one improved spontaneously.

Our analysis of pediatric pH-MII data over a 6-year span highlights that there is potential value in using pH-MII to evaluate for rumination syndrome in centers without access to esophageal manometry. However, more study of this alternative is needed.