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    Rome IV Diagnostic Criteria for Child Rumination Syndrome

    Official Rome IV criteria for the diagnosis of child rumination syndrome.

    INSTRUCTIONS

    Use in children and adolescents with symptoms suggestive of rumination, such as persistent or recurrent regurgitation of recently ingested food into the mouth with subsequent spitting or rechewing and re-swallowing for at least 2 months.

    Patients with any of the following features must be evaluated clinically for other diagnoses even though rumination syndrome may be present:

    • Dysphagia.

    • Odynophagia.

    • Persistent vomiting.

    • Vomiting later than 4h after a meal.

    • Nocturnal vomiting.

    • Unintentional weight loss.

    • Signs of upper gastrointestinal bleeding.

    • Severe abdominal pain.

    When to Use
    Pearls/Pitfalls
    Why Use

    Children and adolescents presenting with recurrent regurgitation of food into the mouth soon after eating a meal for at least 2 months in the absence of an eating disorder. The diagnosis of rumination syndrome should be made by clinical history, physical examination, and minimal laboratory tests.

    • Regurgitation is effortless. It is not preceded by wretching and is not associated with nausea.

    • Regurgitation is often triggered by a feeling of discomfort in the upper abdomen, which is relieved with regurgitation. Regurgitant contains recognizable food that might have a pleasant taste.

    • The rumination process tends to cease when the regurgitated material becomes acidic.

    • An eating disorder needs to be ruled out given association of rumination with bulimia.

    • Rumination can be severe enough to result in weight loss and dehydration.

    • Framing rumination as a tic can be useful. 

    • Delayed gastric emptying can exacerbate rumination. 

    • Rumination can be confirmed with combined high resolution esophageal manometry  with impedance testing. Such testing can also differentiate between different mechanisms of rumination (primary, secondary, supragastric belching) and/or to differentiate it from severe gastroesophageal reflux, but is not necessary to make the diagnosis. 

    • Esophageal manometry can be beneficial to demonstrate to families the rumination mechanism, which may improve treatment success, especially in intractable patients. 

    • Treatment with acid suppression may be indicated to protect the esophagus from damage.  

    • Psychological comorbidities are common and important to address.

    • Helps to make a diagnosis of rumination syndrome.

    • Helps to distinguish rumination from other upper gastrointestinal symptoms such as GERD.

    • Can be used to discuss signs and symptoms of rumination with patients and their family and thereby reduce anxiety and improve compliance with treatment. 

    • Allows for early targeted treatment.

    Must have the following:

    For ≥2 months prior

    Diagnostic Result:

    Please fill out required fields.

    Next Steps
    Evidence
    Creator Insights
    Dr. Douglas Drossman

    About the Creator

    Douglas Drossman, MD, is professor emeritus of medicine and psychiatry at the University of North Carolina School of Medicine. He is founder, President Emeritus and Chief of Operations of the Rome Foundation. He is also the founder of the Drossman Center for the Education and Practice of Biopsychosocial Care and Drossman Consulting, LLC. Dr. Drossman has written over 500 articles and book chapters, has published two books, a GI procedure manual and a textbook of functional GI disorders (Rome I-IV), and serves on six editorial and advisory boards.

    To view Dr. Douglas Drossman's publications, visit PubMed

    Dr. Lin Chang

    About the Creator

    Lin Chang, MD is responsible for the oversight and coordination of the Rome IV calculators on MDCalc. She is a Professor of Medicine at the Vatche and Tamar Manoukian Division of Digestive Diseases at UCLA and is a member of the Rome Foundation Board of Directors.

    To view Dr. Lin Chang's publications, visit PubMed

    The Rome Foundation

    About the Creator

    The Rome Foundation is an independent not for profit 501(c) 3 organization that provides support for activities designed to create scientific data and educational information to assist in the diagnosis and treatment of Disorders of Gut-Brain Interaction (DGBI), also known as functional gastrointestinal (GI) disorders. Their mission is to improve the lives of people with DGBI. Over the last 3 decades, the Rome organization has sought to legitimize and update our knowledge of the DGBIs. This has been accomplished by bringing together scientists and clinicians from around the world to classify and critically appraise the science of GI function and dysfunction. This knowledge permits clinical scientists to make recommendations for diagnosis and treatment that can be applied in research and clinical practice. Diagnosis is based on the use of symptom-based criteria which are used in clinical trials and daily practice. The list of Rome IV categories and the Chair and Co-Chair of each chapter committee are listed below.

    Committees Chair Co-Chair
    Esophageal Disorders Ronnie Fass, MD John Pandolfino, MD
    Gastroduodenal Disorders Nicholas J. Talley, MD, PhD, FRACP Vincenzo Stanghellini, MD
    Bowel Disorders Fermin Mearin, MD Brian Lacy, MD, PhD
    Gallbladder and Sphincter of Oddi Disorders Grace Elta, MD Peter Cotton, MD
    Centrally Mediated Disorders of Gastrointestinal Pain Peter J. Whorwell, MD Laurie Keefer, PhD
    Anorectal Disorders Adil E. Bharucha, MD, MBBS Satish S. C. Rao, MD, PhD, FRCP
    Childhood Functional Gastrointestinal Disorders: Neonate/Toddler Sam Nurko, MD Marc A. Benninga, MD
    Childhood Functional Gastrointestinal Disorders: Child/Adolescent Carlo Di Lorenzo, MD Jeffrey S. Hyams, MD

    Rome IV Diagnostic Criteria Chapters, Chairs and Co-Chairs

    Rome IV Editorial Board: Douglas A. Drossman, MD, Senior Editor, Lin Chang, MD, William D. Chey, MD, John Kellow, MD, Jan Tack, MD, PhD, and William E. Whitehead, PhD.

    To view The Rome Foundation's publications, visit PubMed

    Content Contributors
    • Beate Beinvogl, MD, MPH
    Reviewed By
    • Samuel Nurko, MD, MPH
    About the Creator
    Dr. Douglas Drossman
    Dr. Lin Chang
    The Rome Foundation
    Content Contributors
    • Beate Beinvogl, MD, MPH
    Reviewed By
    • Samuel Nurko, MD, MPH