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Identification of Rumination with Impedance Manometry and High-Resolution Manometry

71

Pokkunuri, Venkata MBBS*; Conklin, Jeffrey MD, FACG; Soffer, Edy MD, FACG; Pimentel, Mark MD

American Journal of Gastroenterology: September 2008 - Volume 103 - Issue - p S29
Supplement Abstracts Submitted for the 73rd Annual Scientific Meeting of the American College of Gastroenterology: ESOPHAGUS
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FRCP (C). Cedars-Sinai Medical Center, Los Angeles, CA.

Purpose: Rumination syndrome is a relatively uncommon disorder that is usually diagnosed on clinical grounds. Two new manometric techniques [impedance manometry and high-resolution manometry (HRM)] are able to track bolus movement in the esophagus. These studies were undertaken to determine if these techniques might be used to identify the forceful regurgitation that is characteristic of rumination syndrome.

Methods: Patients felt to have rumination syndrome by history and the exclusion of other pathological processes were studied with either impedance manometry or HRM. After completion of the standard manometry the impedance catheter was advanced so that the most distal pressure senor was located in the stomach. The HRM catheter was not repositioned. A meal of solids and liquids was eaten, and the manometry was carried out for another hour. The patients were asked to mark when they had typical symptoms.

Results: Rumination was identified with impedance manometry as simultaneous elevations of intragastric and intrathoracic pressures (valsalva) that were associated with a drop in esophageal impedance. This drop in impedance was not associated with swallowing and indicates retrograde bolus movement from the stomach into the esophagus. Typical reflux episodes were seen as retrograde bolus movement without valsalva. The HRM demonstrated the same increases in intagastric and intraesophageal pressures as impedance manometry, but it also identified relaxation of the UES and LES, and the pressure signature of retrograde bolus movement. Figure A is a manometry from a patient with rumination displayed in line mode to simulate a standard manometry. Not its complexity. Figure B is a HRM color contour of the same data.

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Conclusion: Both Impedance manometry and HRM may be helpful in identifying rumination.

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