Multidisciplinary Treatment for Is Effective for Patients With Rumination SyndromeMultidisciplinary Treatment for Is Effective for Patients With Rumination Syndrome https://pediatricsnationwide.org/wp-content/themes/corpus/images/empty/thumbnail.jpg 150 150 Jessica Nye, PhD Jessica Nye, PhD https://secure.gravatar.com/avatar/?s=96&d=mm&r=g
- March 27, 2023
- Jessica Nye, PhD
Tiered, multidisciplinary behavioral treatment is effective at improving symptoms of rumination syndrome (RS) among children and adolescents, even in the outpatient setting.
Children with RS present with repeated, effortless regurgitation of undigested food. Although limited data about treatment are available, previous studies have indicated that inpatient treatment can improve outcomes among pediatric patients with RS. However, such high levels of care are not always possible.
In a paper published in the Journal of Pediatric Gastroenterology and Nutrition, patients treated at Nationwide Children’s Hospital between 2018 and 2020 for RS were retrospectively evaluated for outcomes. Patients received tiered, multidisciplinary care comprising 45-60-minute treatment meals every 2-4 weeks (outpatient treatment) or up to three times daily in the outpatient (intensive outpatient treatment) or inpatient (intensive inpatient treatment) settings. During treatment meals, patients were taught actions and strategies that can help reduce regurgitation.
“The treatment for RS is primarily behavioral, typically under the guidance of a specialized GI psychologist,” says Peter L. Lu, MD, MS, a pediatric gastroenterologist at Nationwide Children’s, associate professor of Pediatrics at The Ohio State University College of Medicine and senior author of this study. “The behavioral techniques that we use include things like using diaphragmatic breathing to relax the abdominal muscles before during and after meals, re-swallowing when rumination and regurgitation does occur, eating smaller portions, pacing meals and separating solids from liquids.”
The study population comprised 124 patients who received outpatient care, 22 who received intensive outpatient care, and 25 who received intensive inpatient care. The patients were aged median 13 years at diagnosis, 64% were girls, 66% vomited daily, and 15% required tube feeding.
The median length of treatment was 6.5 months for outpatient care, four days for intensive outpatient care and nine days for intensive inpatient care.
The rates of improved or resolved symptoms post-treatment were 72%, 95% and 96% for outpatient, intensive outpatient, and intensive inpatient regimens, respectively.
|Treatment Setting||Treatment Duration||Rate of Improved/Resolved Symptoms|
|Intensive outpatient||4 days||95%|
|Intensive inpatient||9 days||96%|
“What was striking to me was how effective the intensive treatment programs are. Both of those groups included the most severe of patients, oftentimes, they’ll have a feeding tube or a central line for parenteral nutrition. Even in that selected, very severe refractory group, we had very good response rates to treatment,” says Dr. Lu.
A subset of 16 patients from the intensive care groups had longer-term follow-up data available (median, 5.3 months). Most (63%-83%) continued to use the behavioral techniques learned during treatment. In addition, 25%-43% took baclofen and one patient in the outpatient cohort and two in the inpatient cohort restarted supplemental feeding.
Currently, Dr. Lu and colleagues are working on a number of studies to better address management of RS. These include developing a symptom score to improve and streamline the diagnosis process, more thoroughly evaluate outcomes of baclofen, which is the only pharmacological treatment available for RS, and assessing the efficacy of delivering behavioral RS treatment via telemedicine, which may broaden access to effective treatment.
“RS is a disorder that cannot be effectively treated by a GI doctor alone,” Dr. Lu says. “It really requires a multidisciplinary team. Treatment of RS involves a GI doctor and a GI psychologist, and we oftentimes will involve one of our GI dieticians or more team members as well. I think [RS management] is a good example of how we can adapt, from a medical standpoint, to better serve the patient. It’s just a good example of the importance of multidisciplinary care.
Sabella J, Van Diest AMK, Bali N, Vaz K, Yacob D, Di Lorenzo C, Lu PL. Multidisciplinary Tiered Care Is Effective for Children and Adolescents With Rumination Syndrome. Journal of Pediatric Gastroenterology and Nutrition. 2023;76(3):282-287.
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