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]
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.
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 intestinal lesions
Other lab tests that may be useful include the following:
-
Esophagogastroduodenoscopy, including cultures for Helicobacter pylori
-
Scintigraphic studies of gastric emptying
-
Radiological studies
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
