Division of Gastroenterology, Department of Medicine, Center for Neurointestinal Health, Massachusetts General Hospital, Boston, MA, USA.
Harvard Medical School, Boston, MA, USA.
Neurogastroenterol Motil. 2021 Aug;33(8):e14103. doi: 10.1111/nmo.14103. Epub 2021 Mar 17.
Rumination syndrome involves effortless, repeated regurgitation, and can overlap with other upper gastrointestinal disorders, including gastroparesis. To inform better diagnostic detection of rumination, we aimed to (1) identify frequency and characteristics of rumination in patients presenting for gastric symptom evaluation; and (2) assess demographic and clinical characteristics that could differentiate those with versus those without rumination.
Consecutively referred patients to two tertiary academic centers for gastric symptom specialty evaluation were included (N = 242). We obtained demographic information, gastric emptying scintigraphy, upper gastrointestinal symptoms using the Patient Assessment of Upper Gastrointestinal Symptoms (PAGI-SYM), and Rome IV-based rumination questionnaire.
Thirty-one of the 242 (12.8%) patients met criteria for rumination syndrome, of which 48% reported associated psychosocial impairment. Comparing those with rumination and those without, there were no differences in race, gender, frequency of diabetes, or frequency of gastroparesis. The median PAGI-SYM score for rumination patients was higher than for those without (3.03 vs. 2.55; unadjusted p = 0.043, adjusted p = 0.30). This was largely driven by increased heartburn/regurgitation subscale scores (2.71 vs. 1.57, unadjusted p = 0.0067, adjusted p = 0.046), itself influenced by elevated daytime regurgitation/reflux (3.0 vs. 2.0; unadjusted p = 0.007, adjusted p = 0.048). There were no significant differences on the remaining PAGI-SYM subscales.
Rumination syndrome determined by Rome IV criteria was present in 12.8% of patients presenting for gastric symptom evaluation. Higher self-report PAGI-SYM heartburn/regurgitation subscale scores, particularly daytime regurgitation/reflux symptoms, were the only parameters that distinguished rumination. The PAGI-SYM heartburn/regurgitation subscale could be used to screen for rumination, in addition to GERDAQ6.
反刍综合征涉及无意识、反复的反流，可能与其他上胃肠道疾病重叠，包括胃轻瘫。为了更好地诊断反刍，我们旨在：（1）确定在因胃症状就诊的患者中反刍的频率和特征；（2）评估可区分有反刍和无反刍患者的人口统计学和临床特征。
连续纳入到两个三级学术中心进行胃症状专科评估的患者（N=242）。我们获取了人口统计学信息、胃排空闪烁扫描、使用患者上胃肠道症状评估量表（PAGI-SYM）评估上胃肠道症状、以及基于罗马 IV 标准的反刍问卷。
242 例患者中有 31 例（12.8%）符合反刍综合征标准，其中 48%报告有相关的心理社会损害。比较有反刍和无反刍的患者，种族、性别、糖尿病频率或胃轻瘫频率无差异。反刍患者的 PAGI-SYM 评分中位数高于无反刍患者（3.03 比 2.55；未校正 p=0.043，校正后 p=0.30）。这主要是由烧心/反流亚量表评分增加（2.71 比 1.57，未校正 p=0.0067，校正后 p=0.046）引起，而烧心/反流亚量表评分增加又主要是由日间反流/反流增加（3.0 比 2.0；未校正 p=0.007，校正后 p=0.048）引起。其余 PAGI-SYM 亚量表无显著差异。
按照罗马 IV 标准确定的反刍综合征在因胃症状就诊的患者中占 12.8%。更高的自我报告 PAGI-SYM 烧心/反流亚量表评分，特别是日间反流/反流症状，是区分反刍的唯一参数。除 GERDAQ6 外，PAGI-SYM 烧心/反流亚量表也可用于筛查反刍。
