title: High Cost and Low Yield: The Diagnostic Evaluation of Rumination Syndrome in Pediatrics.
abstract: To document the use of diagnostic testing in adolescents who ultimately were diagnosed with rumination syndrome, a functional gastrointestinal disorder. We examined the diagnostic yield of each test as well as the associated costs, and we determined if any demographic or illness-related variables impacted the magnitude of the work-up.
  
  
  
  A retrospective chart review was conducted for 68 patients with rumination syndrome admitted to our inpatient treatment program. The cost and findings of patients' diagnostic investigations were gathered, as well as demographic and illness-related variables to determine factors that may be related to evaluation size.
  
  
  
  The most commonly used tests in the evaluation of rumination syndrome included esophagogastroduodenoscopy, gastric emptying, antroduodenal manometry, upper gastrointestinal series, and abdominal ultrasound scan. Each patient underwent an average of 8.8 tests, with the average cost for each patient's diagnostic work-up being US $19 795. Few tests were found to be beneficial in the diagnosis of rumination syndrome, and few demographic or illness variables were found to be related to the overall extent of the investigation.
  
  
  
  Extensive testing for rumination syndrome in adolescents is common in clinical practice, and comes at a high financial cost with low yield, likely delaying diagnosis and treatment. Symptom-based criteria should be used to make the diagnosis of rumination syndrome.
authors.affiliation: Section of Pediatric Psychology and Neuropsychology, Nationwide Children's Hospital, Department of Pediatrics, The Ohio State University, Columbus, OH. Electronic address: anthony.alioto@nationwidechildrens.org.
authors.forename: Anthony
authors.initials: A
authors.lastname: Alioto
authors.affiliation: Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH.
authors.forename: Carlo
authors.initials: C
authors.lastname: Di Lorenzo
authors.affiliation: Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH.
authors.forename: Mary Lee
authors.initials: ML
authors.lastname: Montgomery
authors.affiliation: Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH.
authors.forename: Desale
authors.initials: D
authors.lastname: Yacob
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D000293:Adolescent; D003952:Diagnostic Imaging / Q000191:economics; D017097:Electric Impedance; D016099:Endoscopy, Gastrointestinal / Q000191:economics; D019959:Feeding and Eating Disorders of Childhood / Q000175:diagnosis* / Q000191:economics*; D005260:Female; D005746:Gastric Emptying; D006801:Humans; D007098:Imino Acids / Q000191:economics; D008297:Male; D008365:Manometry / Q000191:economics; D009820:Ohio; D011788:Quality of Life; D012189:Retrospective Studies; D011795:Surveys and Questionnaires
chemical_list: D007098:Imino Acids; C008109:iminodiacetic acid
keywords: Rumination syndrome; diagnostic evaluation; pediatrics; vomiting