title: Objectively diagnosing rumination syndrome in children using esophageal pH-impedance and manometry.
abstract: Rumination syndrome is characterized by recurrent regurgitation of recently ingested food into the mouth. Differentiation with other diagnoses and gastroesophageal reflux disease (GERD) in particular, is difficult. Recently, objective pH-impedance (pH-MII) and manometry criteria were proposed for adults. The aim of this study was to determine diagnostic ambulatory pH-MII and manometry criteria for rumination syndrome in children.
  
  
  
  Clinical data and 24-hour pH-MII and manometry recordings of children with a clinical suspicion of rumination syndrome were reviewed. Recordings were analyzed for retrograde bolus flow extending into the proximal esophagus. Peak gastric and intraesophageal pressures closely related to these events were recorded and checked for a pattern compatible with rumination. Events were classified into primary, secondary, and supragastric belch-associated rumination.
  
  
  
  Twenty-five consecutive patients (11 males, median age 13.3 years [IQR 5.9-15.8]) were included; recordings of 18 patients were suitable for analysis. Rumination events were identified in 16/18 patients, with 50% of events occurring <30 minutes postprandially. Fifteen of 16 patients showed ≥1 gastric pressure peak >30 mmHg, while only 50% of all events was characterized by peaks >30 mmHg and an additional 20% by peaks >25 mmHg. Four patients had evidence of acid GERD, all showing secondary rumination.
  
  
  
  Combined 24-hour pH-MII and manometry can be used to diagnose rumination syndrome in children and to distinguish it from GERD. Rumination patterns in children are similar compared with adults, albeit with lower gastric pressure increase. We propose a diagnostic cutoff for gastric pressure increase >25 mmHg associated with retrograde bolus flow into the proximal esophagus.
authors.affiliation: Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital AMC, Amsterdam, The Netherlands.
authors.forename: M M J
authors.initials: MMJ
authors.lastname: Singendonk
authors.affiliation: Department of Gastroenterology and Hepatology, Academic Medical Center Amsterdam, Amsterdam, The Netherlands.
authors.forename: J M
authors.initials: JM
authors.lastname: Oors
authors.affiliation: Department of Gastroenterology and Hepatology, Academic Medical Center Amsterdam, Amsterdam, The Netherlands.
authors.forename: A J
authors.initials: AJ
authors.lastname: Bredenoord
authors.affiliation: Gastroenterology Unit, Women's and Children's Health Network, North Adelaide, SA, Australia.|Translational Research Center for Gastrointestinal Diseases, University of Leuven, Leuven, Belgium.|School of Medicine, Flinders University, Bedford Park, SA, Australia.
authors.forename: T I
authors.initials: TI
authors.lastname: Omari
authors.affiliation: Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital AMC, Amsterdam, The Netherlands.
authors.forename: R J
authors.initials: RJ
authors.lastname: van der Pol
authors.affiliation: Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital AMC, Amsterdam, The Netherlands.
authors.forename: M J
authors.initials: MJ
authors.lastname: Smits
authors.affiliation: Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital AMC, Amsterdam, The Netherlands.
authors.forename: M A
authors.initials: MA
authors.lastname: Benninga
authors.affiliation: Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital AMC, Amsterdam, The Netherlands.|Department of Pediatric Gastroenterology, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: M P
authors.identifier: 0000-0002-8112-8414
authors.initials: MP
authors.lastname: van Wijk
mesh_terms: D000293:Adolescent; D002648:Child; D017097:Electric Impedance; D050782:Esophageal pH Monitoring / Q000379:methods*; D019959:Feeding and Eating Disorders of Childhood / Q000175:diagnosis*; D005260:Female; D005764:Gastroesophageal Reflux / Q000175:diagnosis*; D006801:Humans; D008297:Male; D008365:Manometry / Q000379:methods*
keywords: gastroesophageal reflux; impedance; manometry; pediatrics; rumination