Department of Neurosciences, Exp ORL, KU Leuven, Leuven, Belgium.
Neurogastroenterol Motil. 2010 Apr;22(4):e97-104. doi: 10.1111/j.1365-2982.2009.01431.x. Epub 2009 Nov 25.
Rumination is an eating disorder clinically suspected in the presence of chronic regurgitation of recently ingested food with subsequent re-mastication and swallowing. Oesophageal manometry is currently used to confirm the diagnosis, however, it is difficult to distinguish rumination from postprandial belching-regurgitation, being the manometric pattern identical in both situations. Oesophageal impedance allows recognition between liquid and gas gastro-oesophageal reflux. Our aims were (i) to improve diagnosis of rumination using combined impedance-manometry (ii) to assess the gastro-oesophageal pressure-flow pattern in rumination events.
Sixteen patients with clinically suspected rumination underwent impedance-manometry monitoring for 1 h after a solid liquid meal. Manometry was first analysed blindly to the impedance pattern. All events marked by the patients and straining episodes were identified. After the manometric analysis, impedance tracings were unblinded and each straining episode was analysed for presence of liquid and/or gas oesophageal retrograde flow. Only rumination events were included for additional evaluation.
Postprandial manometry showed a pattern compatible with rumination in 12/16 patients. In total, impedance-manometry confirmed the clinical diagnosis of rumination in eight of the 16 patients with clinical suspicion of rumination. In 102 clearly identified rumination events, the onset of gastric strain (manometry) occurred before the onset of oesophageal liquid retroflow (impedance) in 58% of cases or simultaneously in 37% of cases. In most cases (86%), oesophageal retrograde flow started after an initial increase in abdominal pressure but before the peak gastric strain pressure.
CONCLUSIONS & INFERENCES: Postprandial impedance-manometry monitoring improves diagnosis of rumination because it allows distinction between rumination and postprandial belching and regurgitation. During rumination, oesophageal liquid retrograde flow is first driven by an early small rise in intragastric pressure preceding the peak pressure observed during straining.
反刍是一种饮食障碍，临床上怀疑在摄入的食物最近反刍后，会出现反复咀嚼和吞咽。食管测压目前用于确认诊断，但很难将反刍与餐后呃逆-反流区分开来，两种情况下的测压模式都是相同的。食管阻抗可识别液体和气体胃食管反流。我们的目的是（i）使用阻抗-测压联合方法改善反刍的诊断，（ii）评估反刍事件中的胃食管压力-流量模式。
16 例临床怀疑反刍的患者在固体液体餐后进行阻抗-测压监测 1 小时。首先对测压模式进行盲法分析。记录所有患者标记和用力的事件。在测压分析后，阻抗描记图被揭盲，分析每个用力事件是否存在液体和/或气体食管逆行流动。仅对反刍事件进行额外评估。
餐后测压显示 16 例患者中有 12 例符合反刍模式。总共，阻抗-测压在 16 例有临床怀疑反刍的患者中确认了 8 例的临床诊断。在 102 个明确识别的反刍事件中，胃张力（测压）的发生早于食管液体反流（阻抗）的发生，在 58%的情况下，或同时在 37%的情况下。在大多数情况下（86%），食管逆行回流在腹部压力最初增加后开始，但在胃张力压力峰值之前。
餐后阻抗-测压监测可改善反刍的诊断，因为它可以区分反刍和餐后呃逆和反流。在反刍期间，食管液体反流首先是由胃内压力的早期小幅度升高驱动的，早于用力期间观察到的峰值压力。
