DDSEP® 8 Quick Quiz

Question 1

Q1. A 14-year-old female with a history of cerebral palsy presents for evaluation due to recurrent regurgitation. By report, she is regurgitating food into her mouth several times daily following meals. Her parents report that the regurgitation does not appear to be painful.

What diagnostic finding could be seen in this patient?

Normal pH/impedance probe findings during sleeping.

Esophageal dysmotility on upper GI series.

Decrease in gastric emptying time.

Esophageal eosinophilia on upper intestinal endoscopy.

Absence of "R-waves" on antroduodenal manometry.

Q1. Correct answer: A. Normal Ph/Impedance probe findings during sleeping.

Rumination syndrome is a functional gastrointestinal disorder that can present in all age groups. The true prevalence of the disorder is unknown, but the condition can be seen more commonly in patients with developmental disorders and other high-risk groups like teenage females. The ROME IV criteria for the condition include at least 2 months of the following: Repeated regurgitation and rechewing or expulsion of food that begins soon after eating and stops with sleeping, is not proceeded by retching, and has no other clear etiology for symptoms. This patient is at higher risk for rumination syndrome with her developmental differences. Her painless regurgitation after eating meets criteria for the condition. Prolonged high-resolution esophageal manometry can identify specific subgroups of rumination. Antroduodenal manometry can detect simultaneous contractions called R-waves that can be seen in some patients with rumination syndrome. Since regurgitation stops with sleeping, pH/Impedance probes demonstrate resolution of symptoms with sleep. The condition is primarily diagnosed clinically, with other studies performed as clinically indicated. Treatment typically consists of behavioral management.

Hyams J et al. Gastroenterology. 2006 Apr;130(5):1527-37.

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