title: Rumination syndrome: when the lower oesophageal sphincter rises.
abstract: BACKGROUND
  Rumination syndrome is an uncommon condition characterised by the self-induced regurgitation from the stomach to the mouth of recently ingested meal that is chewed and reswallowed. Rumination is caused by a voluntary rise in intra-abdominal and intra-gastric pressure leading to the reflux of the gastric content into the oesophagus. However, the precise mechanisms preventing reflux at the gastro-oesophageal junction during the rise in intra-gastric pressure remains unknown.
  
  
  METHODS
  In 5 patients, rumination episodes were monitored using combined multiple intra-luminal impedance monitoring, high resolution manometry, and video-fluoroscopic recording.
  
  
  RESULTS
  We showed that the gastro-oesophageal junction moved from the abdominal cavity into the thorax creating a "pseudo-hernia". This occurred at a range of 1.4 ± 0.3 s before the rise in intra-oesophageal pressure and the gastro-oesophageal reflux.
  
  
  CONCLUSIONS
  This displacement of the gastro-oesophageal junction into thorax, rather than a lower oesophageal sphincter opening, explains the mechanism of voluntary regurgitations occurring during rumination syndrome.
authors.affiliation: Physiology Department and ADEN-EA4311 Research Group, Institute for Biomedical Research, European Institute for Peptide Research (IFRMP 23), Rouen University Hospital, Rouen, France. ggourcy@yahoo.fr
authors.forename: Guillaume
authors.initials: G
authors.lastname: Gourcerol
authors.forename: Pierre
authors.initials: P
authors.lastname: Dechelotte
authors.forename: Philippe
authors.initials: P
authors.lastname: Ducrotte
authors.forename: Anne Marie
authors.initials: AM
authors.lastname: Leroi
mesh_terms: D000328:Adult; D003937:Diagnosis, Differential; D017097:Electric Impedance; D016099:Endoscopy, Gastrointestinal / Q000379:methods; D049630:Esophageal Sphincter, Lower; D004947:Esophagus / Q000378:metabolism / Q000503:physiopathology*; D005260:Female; D005471:Fluoroscopy / Q000379:methods; D005753:Gastric Mucosa / Q000378:metabolism; D005764:Gastroesophageal Reflux / Q000175:diagnosis* / Q000378:metabolism / Q000503:physiopathology; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008297:Male; D008365:Manometry; D011312:Pressure; D012189:Retrospective Studies; D013270:Stomach / Q000503:physiopathology*; D013577:Syndrome; D014741:Video Recording