Department of Gastroenterology and Hepatology, Academic Medical Center Amsterdam, Amsterdam, The Netherlands.
Am J Gastroenterol. 2014 Jan;109(1):52-9. doi: 10.1038/ajg.2013.428. Epub 2013 Dec 24.
The rumination syndrome is a behavioral disorder resulting in recurrent regurgitation of undigested food. The diagnosis of this syndrome is currently based on clinical features. We aimed to determine criteria for the rumination syndrome based on physiological measurements.
We studied patients with clinically confirmed rumination syndrome and gastroesophageal reflux disease (GERD) patients with predominant symptoms of regurgitation. All patients underwent combined high-resolution manometry and pH-impedance measurement after a standardized meal. All reflux events extending to the proximal esophagus were analyzed. Furthermore, ambulatory measurements were performed in the majority of patients.
In the rumination group, the amplitude of the abdominal pressure increase during proximal reflux events and the esophageal pressure peaks were significantly higher compared with GERD patients. None of the GERD patients exhibited abdominal pressure peaks >30 mm Hg, whereas in the rumination patients 70% of the pressure peaks had an amplitude >30 mm Hg. Abdominal pressure patterns were also observed during ambulatory pH impedance-pressure monitoring in the rumination patients. pH-impedance monitoring alone could not differentiate between GERD and rumination, however, a higher percentage of reflux events reached the proximal esophagus in the rumination patients. Notably, three different mechanisms of rumination were observed: (i) primary rumination, in which the abdominal pressure increase preceded the retrograde flow, (ii) secondary rumination, consisting of an increase in abdominal pressure following the onset of a reflux event and (iii) supragastric belch-associated rumination, consisting of a supragastric belch immediately followed by a rumination event.
The diagnosis of the rumination syndrome can be made when reflux events extending to the proximal esophagus that are closely associated with an abdominal pressure increase >30 mm Hg and an esophageal pressure increase are observed during combined pressure-impedance monitoring.
反刍综合征是一种导致未消化食物反复反流的行为障碍。目前，该综合征的诊断基于临床特征。我们旨在基于生理测量确定反刍综合征的标准。
我们研究了经临床证实的反刍综合征患者和以反流为主诉的胃食管反流病（GERD）患者。所有患者均在标准化餐后行高分辨率测压和 pH 阻抗联合测量。所有延伸至近端食管的反流事件均进行分析。此外，大多数患者均进行了动态测量。
在反刍组中，近端反流事件期间腹部压力增加的幅度和食管压力峰值显著高于 GERD 患者。GERD 患者中无一例出现 >30mmHg 的腹部压力峰值，而反刍患者中有 70%的压力峰值幅度>30mmHg。在反刍患者的动态 pH 阻抗-压力监测中也观察到了腹部压力模式。单独的 pH 阻抗监测无法区分 GERD 和反刍，但反刍患者中到达近端食管的反流事件比例更高。值得注意的是，观察到了三种不同的反刍机制：（i）原发性反刍，其中腹部压力增加先于反流；（ii）继发性反刍，由反流事件开始后腹部压力增加组成；（iii）胃上嗳气相关反刍，由胃上嗳气紧接着反刍事件组成。
当在联合压力-阻抗监测中观察到延伸至近端食管的反流事件，并且与 >30mmHg 的腹部压力增加和食管压力增加密切相关时，可以诊断为反刍综合征。
