Detection and characteristics of rumination syndrome in patients presenting for gastric symptom evaluation.
disorders of gut-brain interaction
functional gastrointestinal disorder
gastroparesis
rumination disorder
rumination syndrome
Journal
Neurogastroenterology and motility
ISSN: 1365-2982
Titre abrégé: Neurogastroenterol Motil
Pays: England
ID NLM: 9432572
Informations de publication
Date de publication:
08 2021
08 2021
Historique:
revised:
19
01
2021
received:
14
12
2020
accepted:
25
01
2021
pubmed:
18
3
2021
medline:
27
1
2022
entrez:
17
3
2021
Statut:
ppublish
Résumé
Rumination syndrome involves effortless, repeated regurgitation, and can overlap with other upper gastrointestinal disorders, including gastroparesis. To inform better diagnostic detection of rumination, we aimed to (1) identify frequency and characteristics of rumination in patients presenting for gastric symptom evaluation; and (2) assess demographic and clinical characteristics that could differentiate those with versus those without rumination. Consecutively referred patients to two tertiary academic centers for gastric symptom specialty evaluation were included (N = 242). We obtained demographic information, gastric emptying scintigraphy, upper gastrointestinal symptoms using the Patient Assessment of Upper Gastrointestinal Symptoms (PAGI-SYM), and Rome IV-based rumination questionnaire. Thirty-one of the 242 (12.8%) patients met criteria for rumination syndrome, of which 48% reported associated psychosocial impairment. Comparing those with rumination and those without, there were no differences in race, gender, frequency of diabetes, or frequency of gastroparesis. The median PAGI-SYM score for rumination patients was higher than for those without (3.03 vs. 2.55; unadjusted p = 0.043, adjusted p = 0.30). This was largely driven by increased heartburn/regurgitation subscale scores (2.71 vs. 1.57, unadjusted p = 0.0067, adjusted p = 0.046), itself influenced by elevated daytime regurgitation/reflux (3.0 vs. 2.0; unadjusted p = 0.007, adjusted p = 0.048). There were no significant differences on the remaining PAGI-SYM subscales. Rumination syndrome determined by Rome IV criteria was present in 12.8% of patients presenting for gastric symptom evaluation. Higher self-report PAGI-SYM heartburn/regurgitation subscale scores, particularly daytime regurgitation/reflux symptoms, were the only parameters that distinguished rumination. The PAGI-SYM heartburn/regurgitation subscale could be used to screen for rumination, in addition to GERDAQ6.
Sections du résumé
BACKGROUND
Rumination syndrome involves effortless, repeated regurgitation, and can overlap with other upper gastrointestinal disorders, including gastroparesis. To inform better diagnostic detection of rumination, we aimed to (1) identify frequency and characteristics of rumination in patients presenting for gastric symptom evaluation; and (2) assess demographic and clinical characteristics that could differentiate those with versus those without rumination.
METHODS
Consecutively referred patients to two tertiary academic centers for gastric symptom specialty evaluation were included (N = 242). We obtained demographic information, gastric emptying scintigraphy, upper gastrointestinal symptoms using the Patient Assessment of Upper Gastrointestinal Symptoms (PAGI-SYM), and Rome IV-based rumination questionnaire.
KEY RESULTS
Thirty-one of the 242 (12.8%) patients met criteria for rumination syndrome, of which 48% reported associated psychosocial impairment. Comparing those with rumination and those without, there were no differences in race, gender, frequency of diabetes, or frequency of gastroparesis. The median PAGI-SYM score for rumination patients was higher than for those without (3.03 vs. 2.55; unadjusted p = 0.043, adjusted p = 0.30). This was largely driven by increased heartburn/regurgitation subscale scores (2.71 vs. 1.57, unadjusted p = 0.0067, adjusted p = 0.046), itself influenced by elevated daytime regurgitation/reflux (3.0 vs. 2.0; unadjusted p = 0.007, adjusted p = 0.048). There were no significant differences on the remaining PAGI-SYM subscales.
CONCLUSIONS AND INFERENCES
Rumination syndrome determined by Rome IV criteria was present in 12.8% of patients presenting for gastric symptom evaluation. Higher self-report PAGI-SYM heartburn/regurgitation subscale scores, particularly daytime regurgitation/reflux symptoms, were the only parameters that distinguished rumination. The PAGI-SYM heartburn/regurgitation subscale could be used to screen for rumination, in addition to GERDAQ6.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e14103Informations de copyright
© 2021 John Wiley & Sons Ltd.
Références
Drossman D, Chang L, Chey WD, et al. Functional Gastrointestinal Disorders - Disorders of Gut-Brain Interaction. 4th ed. Raleigh, NC: Rome Foundation: 2016. No. 2.
APA. Diagnostic and Statistical Manual of Mental Disorders (DSM-5), 5th ed. Arlington, VA: American Psychiatric Publishing; 2013.
Murray HB, Juarascio AS, Drossman D, Di Lorenzo C, Thomas JJ. Diagnosis and treatment of rumination syndrome: a critical review. Am J Gastroenterol. 2019;114:562-578.
Chial HJ, Camilleri M, Williams DE, Litzinger K, Perrault J. Rumination syndrome in children and adolescents: diagnosis, treatment, and prognosis. Pediatrics. 2003;111:158-162.
Thomas JJ, Murray HB. Cognitive-behavioral treatment of adult rumination behavior in the setting of disordered eating: a single case experimental design. Int J Eat Disord. 2016;49:967-972.
Murray HB, Juarascio AS, Thomas JJ. Augmenting diaphragmatic breathing with behavioral exposure: single-case experimental design for rumination disorder. Cogn Behav Pract. 2020;27(3):347-356.
Tucker E, Knowles K, Wright J, Fox MR. Rumination variations: aetiology and classification of abnormal behavioural responses to digestive symptoms based on high-resolution manometry studies. Aliment Pharmacol Ther. 2013;37:263-274.
Absah I, Rishi A, Talley N, Katzka D, Halland M. Rumination syndrome: pathophysiology, diagnosis, and treatment. Neurogastroenterol Motil. 2017;29:1-8.
Kessing BF, Bredenoord AJ, Smout AJ. Objective manometric criteria for the rumination syndrome. Am J Gastroenterol. 2014;109:52-59.
Grover M, Farrugia G, Stanghellini V. Gastroparesis: a turning point in understanding and treatment. Gut. 2019;68:2238-2250.
Parkman HP, Hasler W, Fisher R. American Gastroenterological Association technical review on the diagnosis and treatment of gastroparesis. Gastroenterology. 2004;127:1592-1622.
Parkman HP, Yates K, Hasler WL, et al. Clinical features of idiopathic gastroparesis vary with sex, body mass, symptom onset, delay in gastric emptying, and gastroparesis severity. Gastroenterology. 2011;140:101-115.e10.
Wang X, Luscombe GM, Boyd C, Kellow J, Abraham S. Functional gastrointestinal disorders in eating disorder patients: altered distribution and predictors using ROME III compared to ROME II criteria. World J Gastroenterol: WJG. 2014;20:16293.
Delaney CB, Eddy KT, Hartmann AS, Becker AE, Murray HB, Thomas JJ. Pica and rumination behavior among individuals seeking treatment for eating disorders or obesity. Int J Eat Disord. 2015;48:238-248.
Drossman D, Chang L, Chey WD, et al. Rome IV diagnostic questionnaire for the adult functional GI disorders. In: Functional Gastrointestinal Disorders - Disorders of Gut-Brain Interaction. 4th ed. Raleigh, NC: Rome Foundation; 2016.
Rentz A, Kahrilas P, Stanghellini V, et al. Development and psychometric evaluation of the patient assessment of upper gastrointestinal symptom severity index (PAGI-SYM) in patients with upper gastrointestinal disorders. Qual Life Res. 2004;13:1737-1749.
Zickgraf HF, Ellis JM. Initial validation of the Nine Item Avoidant/Restrictive Food Intake Disorder Screen (NIAS): A measure of three restrictive eating behaviors. Appetite. 2018;32-42.
Murray HB, Dreier MJ, Zickgraf HF, et al. Validation the Nine Item ARFID Screen (NIAS) subscales for distinguishing ARFID presentations and screening for ARFID. Int J Eat Disord. 2021;under review.
Murray HB, Jehangir A, Silvernale CJ, Kuo B, Parkman HP. Avoidant/restrictive food intake disorder symptoms are frequent in patients presenting for symptoms of gastroparesis. Neurogastroenterol Motil. 2020;32:e13931.
Stice E, Fisher M, Martinez E. Eating disorder diagnostic scale: additional evidence of reliability and validity. Psychol Assess. 2004;16:60.
Vizcaino EM, Rodriguez-Valcárcel FC, de Los Ríos CC. Rumination syndrome: unknown pathology easy to diagnose with high-resolution impedance manometry. J Neurogastroenterol Motil. 2018;24:503-505.
Palsson O, Whitehead W, van Tilburg M, et al. Development and Validation of the Rome IV Diagnostic Questionnaire for Adults. Gastroenterology. 2016;150(6):1481-1491.
Rajindrajith S, Devanarayana NM, Perera BJC. Rumination syndrome in children and adolescents: a school survey assessing prevalence and symptomatology. BMC Gastroenterol. 2012;12:163.
Chogle A, Velasco-Benitez CA, Koppen IJ, Moreno JE, Ramírez Hernández CR, Saps M. A population-based study on the epidemiology of functional gastrointestinal disorders in young children. J Pediatr. 2016;179:139-143.e1.
Thompson W, Irvine E, Pare P, Ferrazzi S, Rance L. Functional gastrointestinal disorders in Canada: first population-based survey using Rome II criteria with suggestions for improving the questionnaire. Dig Dis Sci. 2002;47:225-235.
López-Colombo A, Morgan D, Bravo-González D, Montiel-Jarquín A, Méndez-Martínez S, Schmulson M. The epidemiology of functional gastrointestinal disorders in Mexico: a population-based study. Gastroenterol Res Pract. 2012;2012:606174.
Koloski NA, Talley NJ, Boyce PM. Epidemiology and health care seeking in the functional GI disorders: a population-based study. Am J Gastroenterol. 2002;97:2290-2299.
Drossman DA, Li Z, Andruzzi E, et al. US householder survey of functional gastrointestinal disorders. Dig Dis Sci. 1993;38:1569-1580.
Barba E, Burri E, Accarino A, et al. Biofeedback-guided control of abdominothoracic muscular activity reduces regurgitation episodes in patients with rumination. Clin Gastroenterol Hepatol. 2015;13:100-106.e1.
Barba E, Accarino A, Soldevilla A, Malagelada J-R, Azpiroz F. Randomized, placebo-controlled trial of biofeedback for the treatment of rumination. Am J Gastroenterol. 2016;111:1007-1013.
Eherer A, Netolitzky F, Högenauer C, et al. Positive effect of abdominal breathing exercise on gastroesophageal reflux disease: a randomized, controlled study. Am J Gastroenterol. 2012;107:372-378.
Halland M, Bharucha AE, Crowell MD, Ravi K, Katzka DA. Effects of diaphragmatic breathing on the pathophysiology and treatment of upright gastroesophageal reflux: a randomized controlled trial. Am J Gastroenterol. 2021;116:86-94.
Murray HB, Zhang F, Call CC, et al. Comprehensive cognitive-behavioral treatment for rumination syndrome: a proof-of-concept trial. Dig Dis Sci. 2020.