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Rumination is the voluntary, albeit subconscious return of gastric contents to the mouth. Currently, rumination syndrome and repetitive belching disorders are considered separate diagnoses, as defined by Rome III criteria and high-resolution esophageal manometry. Dr Fox and colleagues from the United Kingdom tested the hypothesis that these conditions represent a common behavioral response to aversive digestive stimuli, and that successful treatment can be directed at both the stimulus and the response. The team performed a case-note review of consecutive patients with a final diagnosis of behavioral digestive disorders between 2009 and 2011.  | | 35 of 46 patients exhibited ‘classical’ rumination with abdomino-gastric strain | | Alimentary Pharmacology & Therapeutics |
The research team found that 35 of 46 patients exhibited ‘classical’ rumination with abdomino-gastric strain driving gastric contents across the lower esophageal sphincter. The team noted that 5 had ‘reflux-related’ rumination with R-waves seen during gastro-esophageal common cavity events, and 6 had supra-gastric belching. All received at least one biofeedback session at the time of diagnosis with a good response reported by 20 of 46 of the patients, which included 3 with supra-gastric belching. In addition, the researchers found that rumination ceased in cases in which definitive treatment relieved the symptoms that triggered abnormal behavior. Dr Fox's team concluded, "Rumination and many of its variations, excluding only some cases of supra-gastric belching, are associated with abdomino-gastric strain, a generic abnormal behavioral response to a variety of aversive digestive stimuli." "All types of rumination can respond to biofeedback." "High-resolution esophageal manometry identifies subgroups with distinct mechanisms of disease that respond to specific management targeted at the symptoms that trigger the abnormal behavior."
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