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Rumination syndrome


Key sources

The following summarized guidelines for the evaluation and management of rumination syndrome are prepared by our editorial team based on guidelines from the British Society of Gastroenterology (BSG 2019) and the American Gastroenterological Association (AGA 2018). ...
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Screening and diagnosis

Diagnosis: as per BSG 2019 guidelines, consider diagnosing RS clinically on the basis of a typical history.
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Diagnostic investigations

Postprandial high-resolution impedance manometry: as per BSG 2019 guidelines, consider obtaining high-resolution manometry with impedance after a test meal to identify diagnostic features of RS, if the diagnosis is unclear, the patient needs convincing of the diagnosis, or objective evidence is required before therapy.

Medical management

Baclofen: as per AGA 2018 guidelines, consider offering baclofen at a dose of 10 mg TID as a reasonable option in patients with refractory RS.

Nonpharmacologic interventions

Diaphragmatic breathing
As per AGA 2018 guidelines:
Offer diaphragmatic breathing with or without biofeedback as first-line therapy in all patients with RS.
Consider providing instructions for effective diaphragmatic breathing by speech therapists, psychologists, gastroenterologists, and other health practitioners familiar with the technique.