Document resource
Introduction Despite advances in motility diagnostics and brain-gut behavioural therapies expanding potential for combination therapies in Rumination Syndrome, there are minimal clinical data on the utility of combined interventions in augmenting rehabilitation in Rumination Syndrome. We evaluated clinical outcomes from an integrated tertiary clinic with access to manometry guided biofeedback and gut-directed hypnotherapy.Methods Patients with Rumination Syndrome managed in an integrated tertiary neurogastroenterology clinic between 2021-2024 were included in the study. Data were collected on clinical characteristics including symptoms and weight at baseline and follow-up, nutritional and feeding-tube status. Data were also collected on treatment outcomes from those that required monotherapy with first-line diaphragmatic breathing (DB) coaching, and those that required multimodal combination therapies including pharmacological (tricyclic antidepressant (TCA) and/or baclofen), advanced behavioural interventions (oesophageal manometry guided biofeedback, CBT and/or gut-directed hypnotherapy (GDH)), or surgery (Nissen fundoplication). Weight pre- and post-intervention was compared using paired Wilcoxon tests. Categorical variables associated with non-responders were identified via Fisher’s Exact test.Results 33 patients fulfilling Rome IV Rumination Syndrome criteria (mean 34 years ±14.4 SD, 60.5% female, median time from symptom onset to diagnosis 36 months) received integrated multidisciplinary care. All 33 patients received DB coaching. For augmentation, 16/33 (48%) received a TCA, 11/33 (33%) received baclofen, 13/33 (39%) had oesophageal manometry guided biofeedback, 17/33 (52%) received GDH, 3/33 (9%) received CBT and 1/33 (3%) received Nissen Fundoplication. Of 19/33 patients presenting with weight loss or malnutrition at baseline, N=5 required enteral tube feeding. Overall, 23/33 (69.7%) improved at follow-up and were able to keep down food and fluids for longer, had improved oral intake. 26/33 (78.8%) gained weight, which increased from 64.5kg ±17.0 SD at baseline to 68.5kg ±16.0 SD at follow-up (p= 0.0012).Most responders (20/23, 87%) required multimodal therapy whereas N=3 responded to DB monotherapy. All non-responders (N=10) had Rumination for both liquids and solids at baseline, whereas responders were more likely to regurgitate only solids (p=0.009) and N=3 with refractory Rumination symptoms remained dependent on post-pyloric feeding long-term.Conclusions Despite often presenting late with complications, most patients with Rumination Syndrome in tertiary care can be managed effectively with multimodal behavioural and medical interventions in combination. Earlier recognition and prompt intervention are critical in improving outcomes and preventing complications.