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Chronic vomiting in children: A prospective study reveals rumination syndrome is an important etiology that is underdiagnosed and untreated

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Indian Journal of Gastroenterology Aims and scope Submit manuscript

Abstract

Background

The diagnosis of rumination syndrome is frequently overlooked, and under-recognized; children are subjected to unnecessary testing and inappropriate treatment for a condition which can be diagnosed clinically and managed easily. In the first ever systematic exploration of this condition from India, we present a prospective study on children with chronic vomiting in which rumination emerged as the predominant cause.

Methods

This was a prospective study in which all consecutive children (5–18 years) presenting with chronic or recurrent vomiting of at least 2-month duration were enrolled. Clinical history was assessed by a physician-administered questionnaire. All subjects underwent standard testing followed by additional investigations as required. The ROME III criteria were used.

Results

Fifty children (28 boys, age 12.2 + 3 years) were enrolled. Diagnosis was rumination syndrome 30, cyclical vomiting 8, functional vomiting 6, intestinal tuberculosis 4, intestinal malrotation 1, and superior mesenteric artery syndrome 1. Children with rumination syndrome had a relapsing and remitting (12, 40%) or a chronically symptomatic course (18, 60%). These children received incorrect diagnoses (26, 87%) or no diagnosis (3, 10%) and extensive investigation before referral. Before referral, children with rumination syndrome were treated with a median of four drugs (range 1 to 9); two underwent surgery (appendectomy) for their symptoms while one child was subjected to electroconvulsive therapy. Overall, resolution after treatment was seen in 26 (87%) with a relapse in 8 (27%) children.

Conclusion

The diagnosis of rumination syndrome is delayed and these children are often inappropriately treated. Therapy in the form of diaphragmatic breathing has a good success rate.

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Authors and Affiliations

  1. Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226 014, India

    Rohan Malik, Anshu Srivastava, Surender K Yachha & Ujjal Poddar

  2. Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, 110029, India

    Rohan Malik

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  1. Rohan Malik
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  2. Anshu Srivastava
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  3. Surender K Yachha
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  4. Ujjal Poddar
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Correspondence to Rohan Malik.

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RM, AS, SKY, and UP declare that they have no conflict of interest.

Ethics statement

The study was performed conforming to the Helsinki declaration of 1975, as revised in 2000 and 2008 concerning human and animal rights, and the authors followed the policy concerning informed consent as shown on Springer.com.

The study was approved by the institute’s ethics committee.

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Malik, R., Srivastava, A., Yachha, S.K. et al. Chronic vomiting in children: A prospective study reveals rumination syndrome is an important etiology that is underdiagnosed and untreated. Indian J Gastroenterol 39, 196–203 (2020). https://doi.org/10.1007/s12664-020-01025-y

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  • DOI: https://doi.org/10.1007/s12664-020-01025-y

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