Recognition and management of rumination syndrome in the paediatric population

Rumination syndrome is a commonly misdiagnosed condition that presents similarly to gastro-oesophageal reflux disease. It has a higher prevalance in paediatric populations with cognitive delay and requires an elaborate multidisciplinary approach to management. A 13-year-old boy presented to a Dublin children’s hospital with a four-year history of postprandial belching and reflux, on a background history of Down syndrome and autism spectrum disorder. The patient had become increasingly emotionally agitated by the episodes. He had also experienced significant weight loss over the previous year. Management through a standard gastro-oesophageal reflux disease approach was unsuccessful. Bloods, imaging and endoscopy were all normal. No abdominal masses were detected. The patient was diagnosed with rumination syndrome and admitted as an inpatient for multidisciplinary management. A percutaneous endoscopic gastrostomy (PEG) tube was inserted and feeds commenced, which led to slight weight gain. The patient was discharged for home feeding and a follow-up appointment with occupational therapy. Rumination syndrome in populations with cognitive delay requires a uniquely tailored approach to diagnosis and treatment. Standard treatment involves diaphragmatic retraining exercises, which are difficult to teach, or fundoplication, which is not always curative. Therefore, new approaches using biofeedback and pharmacological therapy should be explored for use in paediatric populations with cognitive delay.