Impedance measurements and high-resolution manometry help to better define rumination episodes

Abstract

Background. Rumination syndrome is a disorder of unknown etiology characterized by regurgitation of recently ingested food. We aimed to improve the diagnosis of rumination syndrome by classification of separate rumination symptoms using (1) an ambulatory manometry/impedance (AMIM) measurement and (2) a single-catheter high-resolution manometry/impedance (HRIM) measurement. Methods. A total of 96 symptoms during AMIM and 37 symptoms during HRIM were analyzed in five patients with clinically diagnosed rumination syndrome. Key results. AMIM identified rumination events in 85 out of 96 reported symptoms (symptom index (SI): 89%). Of these events, 63% were non-acidic and would have been missed by pH-metry. HRIM identified 32 out of 37 reported symptoms (SI: 86%). Upper esophageal sphincter (UES) relaxation was observed during all rumination events identified by HRIM and could be an additional criterion in the definition of rumination events. Conclusions. Impedance measurement and high-resolution manometry contribute to a more detailed description of rumination events. Rumination events defined as gastric strain, common cavity phenomenon, retrograde esophageal fluid flow, and UES relaxation show a high SI when measured with AMIM or single-catheter HRIM.

Key Words::

• Belching
• esophageal motility
• functional gastroduodenal disorders
• high-resolution manometry
• impedance monitoring
• rumination syndrome
• regurgitation

Acknowledgements

The authors would like to thank Dr. SA Dello for his contribution to the study concept. Specific author contributions: Study concept and design, acquisition of data, analysis and interpretation of data, drafting of the manuscript, analysis of the data, and approval of the final submitted draft: BF Kessing; study concept, drafting of the manuscript, and approval of the final submitted draft: F Govaert; study concept and design, interpretation of data, critical revision of the manuscript for important intellectual content, and approval of the final submitted draft: AAM Masclee; study concept and design, acquisition of data, interpretation of data, critical revision of the manuscript for important intellectual content, and approval of the final submitted draft: JM Conchillo. Financial support: AAM Masclee is supported by Unilever and DSM.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.