ABSTRACT
Background
Rumination syndrome is a functional gastrointestinal disorder characterized by effortless
postprandial regurgitation and accompanied by gastric visceral hypersensitivity. Almost
invariably, the onset of symptoms is preceded by a psychologically stressful situation,
and anxiety is often an accompanying complaint. In this background of gastric visceral
hypersensitivity, anxiety and psychological stress, we investigated the effectiveness
of combining a tricyclic antidepressant (TCA) with diaphragmatic breathing/relaxation
techniques for the treatment of rumination syndrome.
Materials and Methods
Patients who fulfilled the Rome IV criteria for rumination syndrome received hands-on
instructions and/or coaching on diaphragmatic breathing techniques, were given relaxing
auditory media, started on a TCA, and completed a follow-up symptoms questionnaire
after undergoing a minimum of 3 months of this therapy.
Results
A total of 44 patients, 35 women; mean age 40.4 (range 20-71) were identified. Mean
time from onset of symptoms to diagnosis was 36.0 months (range 6-180). Weight loss
ranged from 1.4 to 39.5 kg. Approximately 65.9% had a history of anxiety and/or depression,
and a separate 65.9% reported the onset of symptoms were chronologically related to
an inciting event and/or psychological stressor. After a mean follow-up period of
8.8 months, 90.9% of patients reported improvement in their symptoms, with a mean
subjective improvement from baseline of 68.9%, and specifically, 45.5% of patients
reported ≥80% improvement. Weight increased or stabilized in 80.6% of those initially
reporting weight loss.
Conclusions
The combination of a TCA with diaphragmatic breathing/relaxation techniques is an
effective treatment modality for the management of rumination syndrome as it addresses
the underlying factors identified in this entity.
Key Indexing Terms
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Article info
Publication history
Published online: April 12, 2020
Accepted:
April 1,
2020
Received:
January 7,
2020
Footnotes
Funding: None.
The authors have no conflicts of interest to disclose.
Identification
Copyright
© 2020 Published by Elsevier Inc. on behalf of Southern Society for Clinical Investigation.
