Rumination Documented by Using Combined Multichannel Intraluminal Impedance and Manometry

According to the Rome criteria, rumination is considered to be an esophageal functional disorder. Because documentation of rumination is difficult, it has been suggested that rumination is a clinical diagnosis. Even though a clinical diagnosis of rumination can be based only on history, this conclusion often leaves both the patient and the physician dissatisfied. In this article we describe the case of a 26-year-old man referred for evaluation of persistent regurgitation. By using combined multichannel intraluminal impedance and manometry we were able to document the sequence of events leading to regurgitation. These include an increase in intra-abdominal pressure identified in the pressure transducer located in the stomach, which initiates the reflux event identified by both impedance changes as well as common cavity phenomenon, followed by peristaltic fore contractions, which clear the intraesophageal content, a pattern highly suggestive for rumination. The opportunity to review these documented changes visually helps to make the patient aware of the functional aspects of the condition, avoiding unwarranted therapies and providing the opportunity to reinforce behavioral modifications.