Clinical outcome of rumination syndrome in adults without psychiatric illness: a prospective study.
OBJECTIVE
This prospective study was conducted to characterize the clinical features of adult rumination syndrome, in the absence of psychiatric illness, by applying newly modified clinical criteria, and to elucidate factors influencing outcomes after treatment.


METHODS
Twenty-one adult patients diagnosed with rumination syndrome at a tertiary referral center over a 2-year period were enrolled in the study. All patients received supportive psychotherapy and medical treatment. Changes in symptom parameters were analyzed using a pretreatment and a post-treatment questionnaire. Patients were classified into three groups according to symptomatic outcome: improved group, sustained group and aggravated group.


RESULTS
The duration of treatment was longer in the improved group than in the sustained or aggravated groups (P = 0.018). Esophageal manometry testing demonstrated non-transmitted contractions of the esophageal body in 10 patients (47.6%) and low amplitude contractions in eight patients (38.1%). Mean lower esophageal sphincter (LES) pressure was 9.8 +/- 2.6 mmHg. Baseline LES pressure in the improved group was higher than in the other groups (P = 0.001). Ambulatory 24-h esophageal pH monitoring showed pathological acid reflux in six patients (28.6%). All pathological acid reflux occurred in post-rumination periods. Scintigraphic testing of gastric emptying revealed that the mean retention rate at 120 min was 34.2 +/- 2.5% of initial contents, and delayed emptying was noted in three patients (14.3%).


CONCLUSIONS
Rumination syndrome is often accompanied by heterogeneous conditions such as postprandial gastroesophageal reflux, various abnormalities in esophageal manometric tests and delayed gastric emptying. Medical treatment and supportive psychotherapy can be effective in otherwise normal adult patients, especially in patients who comply with long durations of treatment and who demonstrate higher baseline LES pressures.
Lee
Hyuk
H
Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Rhee
Poong-Lyul
PL
Park
Eun-Ha
EH
Kim
Jeong Hwan
JH
Son
Hee Jung
HJ
Kim
Jae J
JJ
Rhee
Jong Chul
JC
D000328:Adult; D050782:Esophageal pH Monitoring; D004947:Esophagus / Q000503:physiopathology*; D005260:Female; D005746:Gastric Emptying; D005764:Gastroesophageal Reflux / Q000188:drug therapy / Q000209:etiology* / Q000503:physiopathology; D005765:Gastrointestinal Agents / Q000627:therapeutic use*; D005767:Gastrointestinal Diseases / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D008297:Male; D008365:Manometry; D009119:Muscle Contraction; D010353:Patient Education as Topic; D019518:Postprandial Period; D011312:Pressure; D011446:Prospective Studies; D011613:Psychotherapy; D013469:Sulpiride / Q000031:analogs & derivatives* / Q000627:therapeutic use; D011795:Surveys and Questionnaires; D013577:Syndrome; D013997:Time Factors; D016896:Treatment Outcome
D005765:Gastrointestinal Agents; D013469:Sulpiride; C078143:levosulpiride