Rumination Workup

Updated: Oct 01, 2019
  • Author: Cynthia R Ellis, MD; Chief Editor: Caroly Pataki, MD  more...
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Workup

Approach Considerations

Clinicians strongly should consider rumination syndrome in patients who report consistent postprandial regurgitation. Such patients often are labeled as having refractory gastroesophageal reflux or vomiting. Presence of nocturnal regurgitation, dysphagia, nausea, or symptoms occurring in the absence of meals does not exclude rumination syndrome, but makes the presence of it less likely. Clinicians should diagnose rumination syndrome primarily on the basis of Rome IV criteria after an appropriate medical work-up. [6]

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Laboratory Studies

Perform hematology and chemistry tests to exclude anemia secondary to bleeding caused by esophageal or gastric ulceration and electrolyte imbalances due to the rumination and loss of essential electrolytes.

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Imaging Studies

Barium swallow to demonstrate any of the following:

  • Hiatal hernia

  • Esophageal atresia or other malformations

  • Stricture

  • Achalasia

  • Chalasia

Upper GI series and small bowel follow-through examination to diagnose the following:

Other lab tests that may be useful include the following:

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Other Tests

Extensive and invasive GI testing rarely is indicated but may include the following:

  • GI manometry [7]

  • Upper GI motility

  • Gastric emptying

  • Lower esophageal sphincter pressure

  • Trial of histamine 2 (H2) blockers, metoclopramide, or antacids to rule out underlying causes of rumination when more invasive medical investigation is not possible

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Procedures

Perform 24-hour esophageal pH monitoring to exclude GER.

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