{
  "abstract": "Rumination syndrome is a functional disorder characterised by effortless regurgitation of recently ingested food from the stomach to oral cavity. Diagnosis is clinical, based on Rome IV criteria, with high-resolution oesophageal impedance manometry (HRM) often performed in cases of diagnostic uncertainty. Although imaging is not routinely indicated in the absence of diagnostic uncertainty, expanded diagnostic evaluations remain common to exclude organic pathology. This study aimed to assess the diagnostic yield of expanded diagnostic evaluations among paediatric patients with clinically diagnosed rumination syndrome at a regional UK paediatric gastroenterology centre.We conducted a retrospective chart review of 40 children with clinically diagnosed rumination syndrome and had further diagnostic investigations between March 2019 and October 2024. All included children met Rome IV criteria for rumination syndrome and underwent HRM ± additional investigations. Data extracted from electronic medical records included demographic information, medical history, and findings of any of the following investigations: HRM, pH impedance test, oesophagogastroduodenoscopy (OGD), contrast study, gastric emptying scan, and abdominal ultrasound. Descriptive statistics summarised the distribution and diagnostic yield of these studies. This project was deemed exempt from ethics review and categorised as an audit of clinical practice.Across the 40-patient cohort, the mean age was 11.05 years (SD 3.67) and 55% were female. Each child underwent an average of 3 investigations. Following HRM, the most frequently performed study was OGD ± biopsy (78%), then contrast study (55%), pH impedance study (40%), abdominal ultrasound (18%), and gastric emptying scan (5%). HRM identified rumination syndrome in only 40% of patients. Of the remaining 60% with non-diagnostic HRM, further investigations were normal or nonspecific in 91% of cases and 9% had findings consistent with gastro oesophageal reflux disease (GORD). pH impedance testing identified GORD in each of these cases. There was 1 case in which both rumination and GORD were diagnosed through the expanded evaluation. No alternative diagnoses were identified by OGD, biopsies, contrast studies, abdominal ultrasound, or gastric emptying scans.Our clinical data demonstrates that among children meeting clinical criteria for rumination syndrome, the diagnostic yield of additional investigation is limited. There may be few cases in which an expanded evaluation identifies GORD as an alternative or concurrent diagnosis, based on interpreting HRM and pH impedance findings together. However, the large predominance of normal or nonspecific findings may inadvertently increase diagnostic uncertainty, patient burden, and healthcare utilisation while delaying treatment. Clinicians should therefore carefully consider their suspicion for organic pathology before expanding their diagnostic evaluation. In the case of initial diagnostic uncertainty, HRM and pH impedance testing are likely to have the greatest diagnostic yield in these patients, and should therefore be prioritised. Further prospective and large sample studies are warranted to refine diagnostic pathways for rumination syndrome in children.",
  "authors": [
    {
      "affiliations": [
        "Kings College London, UK"
      ],
      "name": "Hami HZ Zaman"
    },
    {
      "affiliations": [
        "Kings College London, UK"
      ],
      "name": "Rachel RE Earley"
    },
    {
      "affiliations": [
        "Department of paediatrics - University of California, San Francisco, US"
      ],
      "name": "Eisha EJ Jain"
    },
    {
      "affiliations": [
        "Department of paediatric gastroenterology - King Abdulaziz University Hospital, Jeddah, Saudi Arabia"
      ],
      "name": "Zinab ZS Sawan"
    },
    {
      "affiliations": [
        "Department of paediatric gastroenterology - St Thomas Hospital, London, UK",
        "Kings College London, UK"
      ],
      "name": "Mohamed MM Mutalib"
    }
  ],
  "title": "OC10 Yield of expanded diagnostic evaluation in children with clinically-diagnosed rumination syndrome",
  "uid": "ce251d5c-4e60-5aec-91d7-66935e8f175a"
}