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Sartori R, Della Torca A, Bramuzzo M, Barbi E, Tessitore A. Nonpharmacological treatment of rumination syndrome in childhood: A systematic review of the literature. J Pediatr Gastroenterol Nutr 2024; 78:763-773. [PMID: 38268062 DOI: 10.1002/jpn3.12038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 08/01/2023] [Accepted: 08/13/2023] [Indexed: 01/26/2024]
Abstract
Rumination syndrome (RS) is a complex functional disorder characterized by recurrent, repetitive regurgitation of recently swallowed food. RS may have medical and psychosocial implications, compromising the quality of life and causing high rates of school absenteeism. Pediatric RS has been poorly studied and little evidence regarding its treatment is available. This systematic review aims to evaluate the literature on the nonpharmacological treatment of RS in childhood. A systematic literature search was conducted on MEDLINE/PubMed, CINAHL, Cochrane Library, PsycINFO, and PEDro, from 2000 to 2023. The methodological quality of the publications was assessed by applying the guidelines proposed by the Equator network, according to the different designs of study, and the risk of bias was evaluated with the Risk Of Bias In Non-Randomized Studies of Interventions (ROBINS-I). Five hundred ninety-six studies were screened, and 7 studies were included in the review. Diaphragmatic breathing was the most used nonpharmacological treatment, and it was always combined with other therapeutic strategies. The vast heterogeneity of the physical or mental comorbidities and the methodology adopted in the publications did not allow a comparative analysis of the different treatments. Regardless of the type of treatment, high-intensity therapeutic programs and specific operators' training emerged as the most influencing factors for patients' outcomes. According to the available evidence, there is not enough high-quality evidence to suggest a defined therapeutic strategy. Large observational studies on selected patients accounting for possible confounders, with adequate follow-up times, and with clearly defined treatment regimens are needed to identify the best therapeutic approach.
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Affiliation(s)
- Roberta Sartori
- Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy
| | - Aurora Della Torca
- Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy
| | - Matteo Bramuzzo
- Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy
| | - Egidio Barbi
- Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Antimo Tessitore
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
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Gupta SR, Lu PL, Vaz KH, Yacob D, Wall J, Van Diest AMK, Di Lorenzo C, Bali N. A Retrospective Review of Baclofen Treatment for Children with Rumination Syndrome at a Single Center. Paediatr Drugs 2023; 25:359-363. [PMID: 36943582 DOI: 10.1007/s40272-023-00567-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/28/2023] [Indexed: 03/23/2023]
Abstract
BACKGROUND Baclofen can decrease rumination frequency in adults with rumination syndrome. Outcomes of baclofen treatment in children with rumination syndrome have not been described. The aim of this study was to examine the safety and efficacy of baclofen in children with rumination syndrome in combination with behavioral therapy at a single center. METHODS We performed a retrospective review of children aged 0-18 years with rumination syndrome based on Rome criteria and prescribed baclofen by a pediatric gastroenterologist at the Nationwide Children's Hospital, Columbus, Ohio, USA, between 2012 and 2019. Children without follow-up data or who were prescribed baclofen for other symptoms were excluded. RESULTS We identified 44 children with rumination syndrome who were prescribed baclofen by a pediatric gastroenterologist. Seventeen either did not have follow-up data or never started the medication. We included 27 patients in the study: 22 (81.5%) female, median age 14.5 years (range 10-18 years) and 100% Caucasian. Twenty patients (74%) received baclofen 5 mg and seven patients (26%) received baclofen 10 mg three times daily. Most patients received behavioral therapy and baclofen simultaneously. Thirteen patients (48%) reported improvement in symptoms, primarily a decrease in rumination frequency, at their first follow-up visit. Regurgitation frequency per week decreased after starting baclofen (p < 0.05). One patient experienced dizziness. No other side effects were reported. CONCLUSION Nearly half of our patients with rumination syndrome improved after baclofen. It was well tolerated with minimal side effects. This suggests that baclofen in addition to behavioral therapy can improve symptoms of rumination syndrome. Prospective, controlled studies in a larger cohort of children with rumination syndrome are needed to confirm these findings.
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Affiliation(s)
- Shivani R Gupta
- Department of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA.
| | - Peter L Lu
- Department of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA
| | - Karla H Vaz
- Department of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA
| | - Desale Yacob
- Department of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA
| | - Jody Wall
- Department of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA
| | - Ashley M Kroon Van Diest
- Department of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA
- Department of Pediatric Psychology and Neuropsychology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Carlo Di Lorenzo
- Department of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA
| | - Neetu Bali
- Department of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA
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Alcala-Gonzalez LG, Serra X, Barba E. Rumination syndrome: Critical review. GASTROENTEROLOGIA Y HEPATOLOGIA 2021; 45:155-163. [PMID: 34023479 DOI: 10.1016/j.gastrohep.2021.03.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 03/22/2021] [Accepted: 03/24/2021] [Indexed: 11/20/2022]
Abstract
Rumination syndrome is a functional disorder characterized by the involuntary regurgitation of recently swallowed food from the stomach into the mouth, from where it can be re-chewed or expelled. Clinically, it is characterized by repeated episodes of effortless food regurgitation. The most usual complaint is frequent vomiting. The physical mechanism that generates regurgitation events is dependent on an involuntary process that alters abdominal and thoracic pressures accompanied by a permissive oesophageal-gastric junction. The diagnosis of rumination syndrome is clinical, highlighting the importance of performing an exhaustive anamnesis on the characteristics of the symptoms. Complementary tests are used to corroborate the diagnosis or rule out organic pathology. Treatment is focused on behavioural therapies as the first line, reserving pharmacological and surgical therapies for refractory cases.
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Affiliation(s)
- Luis Gerardo Alcala-Gonzalez
- Departamento de Gastroenterología, Vall d'Hebron Hospital Universitari, Vall d'Hebron, Barcelona, España; Facultad de Medicina(,) Universitat Autònoma de Barcelona, Bellaterra, España
| | - Xavier Serra
- Departamento de Gastroenterología, Vall d'Hebron Hospital Universitari, Vall d'Hebron, Barcelona, España
| | - Elizabeth Barba
- Departamento de Gastroenterología, Unidad de Motilidad Digestiva, Hospital Clínic, Barcelona, España.
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Giménez Casado A, López Liñán MJ, Barba Orozco E, Accarino Garaventa A, Álvarez Beltrán M, Azpiroz Vidaur F, Segarra Cantón O. Rumination syndrome: Diagnostic and therapeutic difficulties of a not so uncommon disorder. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2018. [DOI: 10.1016/j.anpede.2017.03.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Giménez Casado A, López Liñán MJ, Barba Orozco E, Accarino Garaventa A, Álvarez Beltrán M, Azpiroz Vidaur F, Segarra Cantón O. [Rumination syndrome: Diagnostic and therapeutic difficulties of a not so uncommon disorder]. An Pediatr (Barc) 2017; 88:100-105. [PMID: 28460821 DOI: 10.1016/j.anpedi.2017.03.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 02/20/2017] [Accepted: 03/17/2017] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Rumination syndrome is an uncommon gastrointestinal functional disorder that may be difficult to diagnose, as not many physicians are aware of this condition. In many cases, patients undergo numerous tests and are prescribed several treatments based on erroneous diagnoses. When the correct diagnosis is eventually made, therapy for the syndrome can be difficult and complex because of its multifactorial nature. The aim of this study was to present our experience with this condition, by presenting an analysis of the clinical, diagnostic, and therapeutic data of our patients. PATIENTS AND METHOD A prospective and retrospective study was conducted on all cases of rumination syndrome diagnosed between January 2010 and May 2016 in patients attending the Paediatric Gastroenterology Departments of two hospitals: Consorci Sanitari de Terrassa and Hospital Materno-Infantil Vall d'Hebron (Barcelona, Spain). RESULTS The analysis included 12 patients, with a mean age at the onset of symptoms of 9 years and 1 month, and the mean time period to make the diagnosis was 2 years and 3 months. A mean of 8.1 complementary tests were carried out before establishing the diagnosis. In 10 of the 12 patients, some type of treatment had been given before the diagnosis of rumination syndrome, but was unsuccessful in all cases. Ten of our patients underwent the novel, experimental biofeedback therapy. CONCLUSIONS Due to the limited knowledge of this condition among attending professionals in terms of the clinical presentation, diagnosis, and treatment, patients with rumination syndrome are often misdiagnosed and undergo numerous avoidable complementary tests, and invasive, costly treatments.
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Affiliation(s)
- Aida Giménez Casado
- Unidad de Gastroenterología Pediátrica, Servicio de Pediatría, Consorci Sanitari de Terrassa, Terrassa, Barcelona, España.
| | - María José López Liñán
- Unidad de Gastroenterología Pediátrica, Servicio de Pediatría, Consorci Sanitari de Terrassa, Terrassa, Barcelona, España
| | - Elisabeth Barba Orozco
- Unidad de Motilidad Digestiva, Servicio de Aparato Digestivo, Hospital Universitario Vall d'Hebron, Barcelona, España
| | - Anna Accarino Garaventa
- Unidad de Motilidad Digestiva, Servicio de Aparato Digestivo, Hospital Universitario Vall d'Hebron, Barcelona, España
| | - Marina Álvarez Beltrán
- Unidad de Gastroenterología, Hepatología, Soporte Nutricional y Trasplante Hepático Pediátrico, Servicio de Pediatría, Hospital Universitario Vall d'Hebron, Barcelona, España
| | - Fernando Azpiroz Vidaur
- Unidad de Motilidad Digestiva, Servicio de Aparato Digestivo, Hospital Universitario Vall d'Hebron, Barcelona, España
| | - Oscar Segarra Cantón
- Unidad de Gastroenterología, Hepatología, Soporte Nutricional y Trasplante Hepático Pediátrico, Servicio de Pediatría, Hospital Universitario Vall d'Hebron, Barcelona, España
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Hyams JS, Di Lorenzo C, Saps M, Shulman RJ, Staiano A, van Tilburg M. Functional Disorders: Children and Adolescents. Gastroenterology 2016; 150:S0016-5085(16)00181-5. [PMID: 27144632 DOI: 10.1053/j.gastro.2016.02.015] [Citation(s) in RCA: 695] [Impact Index Per Article: 86.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Accepted: 02/09/2016] [Indexed: 02/07/2023]
Abstract
Characterization of childhood and adolescent functional gastrointestinal disorders (FGIDs) has evolved during the two decade long Rome process now culminating in Rome IV. The era of diagnosing a FGID only when organic disease has been excluded is waning,as we now have evidence to support symptom-based diagnosis. In child/adolescent Rome IV we extend this concept by removing the dictum that there was "no evidence for organic disease" in all definitions and replacing it with "after appropriate medical evaluation the symptoms cannot be attributed to another medical condition". This change allows the clinician to perform selective or no testing to support a positive diagnosis of a FGID. We also point out that FGIDs can coexist with other medical conditions that themselves result in gastrointestinal symptoms (e.g., inflammatory bowel disease). In Rome IV functional nausea and functional vomiting are now described. Rome III "abdominal pain related functional gastrointestinal disorders" (AP-FGID) has been changed to functional abdominal pain disorders (FAPD) and we have derived a new term, "functional abdominal pain -not otherwise specified", to describe children who do not fit a specific disorder such as irritable bowel, functional dyspepsia, or abdominal migraine. Rome IV FGID definitions should enhance clarity for both clinicians and researchers.
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Affiliation(s)
- Jeffrey S Hyams
- Head, Division of Digestive Diseases, Hepatology, and Nutrition, Connecticut Children's Medical Center, 282 Washington Street, Hartford, CT 06101
| | - Carlo Di Lorenzo
- Head, Division of Digestive Diseases, Hepatology, and Nutrition, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205
| | - Miguel Saps
- Division of Digestive Diseases, Hepatology, and Nutrition, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205
| | - Robert J Shulman
- Baylor College of Medicine, Children's Nutrition Research Center, Texas Children's Hospital, 1100 Bates Street, Houston, TX 77030
| | - Annamaria Staiano
- Department of Translational Science, Section of Pediatrics, University of Naples, Federico II, Via S. Pansini, 5 80131 Naples, Italy
| | - Miranda van Tilburg
- University of North Carolina at Chapel Hill Department of Gastroenterology and Hepatology 130 Mason Farm rd, #4106 CB 7080 Chapel Hill NC
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