Clinical Differences in Early-Onset and Adolescent-Onset Rumination Syndrome

Study suggests rumination syndrome in young children is less severe initially and improves over time.  

Early-onset rumination syndrome is clinically distinct from adolescent-onset rumination syndrome, according to a new report out of Nationwide Children’s Hospital. In this largest study of pediatric patients with rumination syndrome to date, researchers found differences in sex distribution, co-occurring conditions and severity of initial presentation between adolescents and young children with the disorder.

Rumination syndrome (RS) is a disorder of gut-brain interaction that can begin in infancy/early childhood or in adolescence. Early-onset RS is challenging to diagnose and treat, as young children may have difficulty understanding the behavioral treatment strategies often recommended for older patients. Research on early-onset RS is lacking, and there is no standardized treatment for this population.

“Rumination syndrome is a disorder that is under-studied, under-recognized and oftentimes misdiagnosed,” says Peter Lu, MD, a pediatric gastroenterologist at Nationwide Children’s and senior author of the study. “At our rumination treatment program, we receive referrals from all over the country for evaluation and treatment of suspected rumination syndrome.”

Dr. Lu and colleagues leveraged data from children diagnosed with RS at Nationwide Children’s to compare the characteristics and outcomes of early-onset (ages five years and younger) and adolescent-onset (ages older than 12 years) patients.

The researchers found differences in the characteristics, initial severity and clinical course between the two age groups, suggesting that the origin and natural history of early-onset RS may be distinct from that of adolescent-onset RS.

For example, early-onset RS was equally likely to occur in boys and girls and was more likely to be associated with developmental delay, while adolescent-onset RS predominantly affected girls and was more likely to be associated with depression or anxiety.

Early-onset RS also had a less severe initial presentation than adolescent-onset RS; early-onset patients ruminated more but vomited less and skipped fewer meals, resulting in less weight loss and dependence on tube feeding or parenteral nutrition.

Finally, despite limited treatment strategies for RS in young children, most early-onset RS patients improved over two years of follow-up. “For these young kids, it may be enough to make sure they are supported from a nutrition and growth standpoint and ensure they don’t develop complications, such as dental erosions, and they will improve with time,” says Dr. Lu.

The research team has several more studies on RS in progress, both to better understand the disorder and more effectively treat it in patients of all ages.

“Rumination syndrome can cause debilitating symptoms and have a big impact on a child’s quality of life,” says Dr. Lu, who is also an associate professor of pediatrics at The Ohio State University College of Medicine. “These patients deserve more research and education about this diagnosis within our medical community so we can pick it up earlier and get them the treatment they need without the delay that they oftentimes experience.”

Reference:

Yang DM, Sabella J, Kroon Van Diest A, Bali N, Vaz K, Yacob D, Di Lorenzo C, Lu PL. Early childhood-onset rumination syndrome is clinically distinct from adolescent-onset rumination syndrome. Journal of Pediatric Gastroenterology and Nutrition. 2024 Mar;78(3):565-572. doi: 10.1002/jpn3.12116. Epub 2024 Jan 23.