Rumination syndrome in children and adolescents: a school survey assessing prevalence and symptomatology

BMC Gastroenterology

Bonaventure Jayasiri Crispus Perera²  Niranga Manjuri Devanarayana¹  Shaman Rajindrajith³ 

[1] Department of Physiology, Faculty of Medicine, University of Kelaniya, Thalagolla Road, Ragama, 11010, Sri Lanka;Postgraduate Institute of Medicine, University of Colombo, Colombo, Sri Lanka;Department of Paediatrics, Faculty of Medicine, University of Kelaniya, Thalagolla Road, Ragama 11010, Sri Lanka

关键词: Rumination syndrome;    Functional gastrointestinal disorder;    Epidemiology;    Child;    Adolescent;   

Others  :  858297
DOI  :  10.1186/1471-230X-12-163

 received in 2012-03-18, accepted in 2012-11-13,  发布年份 2012

【 摘 要 】

Background

Rumination syndrome (RS) is a functional gastrointestinal disorder (FGD) increasingly recognized in children and adolescents. The epidemiology of this condition in school aged children is poorly understood. The main objective of this study was to assess the prevalence of rumination and other related associations in a cohort of Sri Lankan children.

Methods

Children aged 10-16 years were randomly selected from 8 schools in 4 provinces in Sri Lanka. RS was diagnosed using Rome III criteria. Data was collected using a self administered questionnaire distributed in an examination setting. It was translated into Sinhala, the native language and pretested before distribution.

Results

A total of 2163 children were included in the study (55% boys, mean age 13.4 years, SD 1.8 years). Prevalence of RS was 5.1% (n = 110); boys 5.1% and girls 5.0%. When symptoms were analyzed, 73.6% reported re-swallowing of regurgitated food, while the rest spat it out. In 94.5% regurgitation occurred during the first hour after the meal. Only 8.2% had daily symptoms while 62.7% had symptoms weekly. Abdominal pain, bloating and weight loss were the commonest symptoms associated with RS (19.1%, 17.3% and 11.8% respectively). No significant association was observed between exposure to stressful events and rumination (p > 0.05). Twenty (18.2%) with RS fulfilled Rome III criteria for at least one other FGD. School absenteeism was seen in 11.8% of affected children.

Conclusion

RS was reasonably common in this cohort of school-aged children and adolescents in Sri Lanka. However, symptoms were severe enough to affect schooling only in 12% of affected children. Around one fifth with RS had at least one other overlapping FGD.

【 授权许可】

   
2012 Rajindrajith et al.; licensee BioMed Central Ltd.

【 图 表 】

【 参考文献 】

• [1]Rasquin A, Di Lorenzo C, Forbes D, Guiraldes E, Hyams JS, Staiano A, Walker LS: Childhood functional gastrointestinal disorders: child/adolescent. Gastroenterology 2006, 130(5):1527-1537.
• [2]Rasquin-Weber A, Hyman PE, Cucchiara S, Fleisher DR, Hyams JS, Milla PJ, Staiano A: Childhood functional gastrointestinal disorders. Gut 1999, 45(Suppl 2):II60-II68.
• [3]O’Brien MD, Bruce BK, Camilleri M: The rumination syndrome: clinical features rather than manometric diagnosis. Gastroenterology 1995, 108(4):1024-1029.
• [4]Chial HJ, Camilleri M, Williams DE, Litzinger K, Perrault J: Rumination syndrome in children and adolescents: diagnosis, treatment, and prognosis. Pediatrics 2003, 111(1):158-162.
• [5]Chatoor I, Dickson L, Einhorn A: Rumination: etiology and treatment. Pediatr Ann 1984, 13(12):924-929.
• [6]Rogers B, Stratton P, Victor J, Kennedy B, Andres M: Chronic regurgitation among persons with mental retardation: a need for combined medical and interdisciplinary strategies. Am J Ment Retard 1992, 96(5):522-527.
• [7]Khan S, Hyman PE, Cocjin J, Di Lorenzo C: Rumination syndrome in adolescents. J Pediatr 2000, 136(4):528-531.
• [8]Lee H, Rhee PL, Park EH, Kim JH, Son HJ, Kim JJ, Rhee JC: Clinical outcome of rumination syndrome in adults without psychiatric illness: a prospective study. Gastroenterol Hepatol 2007, 22(11):1741-1747.
• [9]Devanarayana NM, de Silva DGH, de Silva HJ: Recurrent abdominal pain syndrome in a cohort of Sir Lankan children and adolescents. J Trop Pediatr 2008, 54:178-183.
• [10]Walker LS, Caplan A, Rasquin A: Rome III diagnostic questionnaire for the pediatric functional GI disorders. In Rome III: the functional gastrointestinal disorders. Edited by Drossman DA, Corazziari E, Delvaux M, Talley NJ, Thompson WG, Whitehead WE. McLean, VA: Degnon Associates; 2006:961-990.
• [11]Devanarayana NM, Adhikari C, Pannala W, Rajindrajith S: Prevalence of functional gastrointestinal diseases in a cohort to Sri Lankan adolescents: comparison between Rome II and Rome III criteria. J Trop Pediatr 2011, 57(1):34-39.
• [12]Drossman DA, Li Z, Andruzzi E, Temple RD, Talley NJ, Thompson WG, Whitehead WE, Janssens J, Funch-Jensen P, Corazziari E: U. S. Householder survey of functional gastrointestinal disorders. Prevalence, sociodemography, and health impact. Dig Dis Sci 1993, 38(9):1569-1580.
• [13]Winton A, Singh NN: Rumination in pediatric populations: a behavioral analysis. J Am Acad Child Psychiatry 1983, 22(3):269-275.
• [14]Rast J, Johnston JM, Drum C, Conrin J: The relation of food quantity to rumination behavior. J Appl Behav Anal 1981, 14(2):121-130.
• [15]Rast J, Ellinger-Allen JA, Johnston JM: Dietary management of rumination: four case studies. Am J Clin Nutr 1985, 42(1):95-101.
• [16]Dalton WT 3rd, Czyzewski DI: Behavioral treatment of habitual rumination: case reports. Dig Dis Sci 2009, 54(8):1804-1807.
• [17]Green AD, Alioto A, Mousa H, Di Lorenzo C: Severe pediatric rumination syndrome: successful interdisciplinary inpatient management. J Pediatr Gastroenterol Nutr 2011, 52(4):414-418.
• [18]Fernandez S, Aspirot A, Kerzner B, Friedlander J, Di Lorenzo C: Do some adolescents with rumination syndrome have “supragastric vomiting”? J Pediatr Gastroenterol Nutr 2010, 50(1):103-105.
• [19]Thumshirn M, Camilleri M, Hanson RB, Williams DE, Schei AJ, Kammer PP: Gastric mechanosensory and lower esophageal sphincter function in rumination syndrome. Am J Physiol 1998, 275(2 Pt 1):G314-G321.
• [20]Soykan I, Chen J, Kendall BJ, McCallum RW: The rumination syndrome: clinical and manometric profile, therapy, and long term outcome. Dig Dis Sci 1997, 42(9):1866-1872.
• [21]Devanarayana NM, Mettananda S, Liyanarachchi C, Nanayakkara N, Mendis N, Perera N, Rajindrajith S: Abdominal pain-predominent functional gastrointestinal diseases in children and adolescents: prevalence, symptomatiology and association with emotional stress. J Pediatr Gastroenterol Nutr 2011, 53(6):659-665.
• [22]Devanarayana N, Rajindrajith S: Aerophagia among Sri Lankan school children: epidemiological patterns and symptom characteristics. J Pediatr Gastroenterol Nutr 2012, 54(4):516-20.
• [23]Devanarayana NM, Rajindrajith S, Rathnamalala N, Samaraweera S, Benninga MA: Delayed gastric emptying rates and impaired antral motility in children fulfilling Rome III critera for functional abdominal pain. Neurogastroenterol Motil 2012, 58(4):280-5.
• [24]Amarnath RP, Bell TL, Malagelada JR: The rumination syndrome in adults. A characteristic manometric pattern. Ann Intern Med 1986, 105(4):513-518.
• [25]Locke GR 3rd, Zinsmeister AR, Fett SL, Melton LJ 3rd, Talley NJ: Overlap of gastrointestinal symptom complexes in a US community. Neurogastroenterol Motil 2005, 17(1):29-34.
• [26]Caplan A, Walker L, Rasquin A: Validation of the pediatric Rome II criteria for functional gastrointestinal disorders using the questionnaire on pediatric gastrointestinal symptoms. J Pediatr Gastroenterol Nutr 2005, 41(3):305-316.
• [27]Helgeland H, Flagstad G, Grotta J, Vandvik PO, Kristensen H, Markestad T: Diagnosing pediatric functional abdominal pain in children (4-15 years old) according to the Rome II Criteria: results from a Norwegian prospective study. J Pediatr Gastroenterol Nutr 2009, 49(3):309-315.
• [28]Tack J, Talley NJ, Camillari M, Holtmann G, Hu P, Malagelada JR, Stanghellini V: Functional gastroduodenal disorders. In Rome III: the functional gastrointestinal disorders. 3rd edition. Edited by Drossman DA, Corazziari E, Delvaux M, Talley NJ, Thompson WG, Whitehead WE. Verginia: Degnon Associates Inc; 2006:429-486.
• [29]DiLorenzo C, Rasquin A, Forbes D, Guiraldes E, Hyams JS, Staiano A, Walker LS: Childhood functional gastrointestinal disorders:child/adolescent. In Rome III: the functional gastrointestinal disorders. 3rd edition. Edited by Drossman DA, Corazziari E, Delvaux M, Talley NJ, Thompson WG, Whitehead WE. Verginia: Degnon Associates Inc; 2006:723-777.
• [30]Tack J, Blondeau K, Boecxstaens V, Rommel N: Review article: the pathophysiology, differential diagnosis and management of rumination syndrome. Aliment Pharmacol Ther 2011, 33(7):782-788.
• [31]Tack J, Talley NJ: Gastroduodenal disorders. Am J Gastroenterol 2010, 105(4):757-763.
• [32]Nicholls D, Bryant-Waugh R: Eating disorders of innfancy and childhood: definition, symptomatology, epidemiology and comorbidity. Child Adolesc Psychiatr Clin N Am 2009, 18(1):17-30.
• [33]Van Son GE, van Hoeken D, Bartelds AIM, van Furth EF: Time trends in the incidence of eating disorders: a primary care study in the Netherlands. Int J Eating Dis 2006, 39(7):565-569.
• [34]Marlais M, Fishman JR, Fell JME, Haddad MJ, Rawat DJ: UK incidence of achalasia: an 11-year national epidemiology study. Arch Dis Child 2011, 96(2):192-194.