Home Menu Gallery Our Story That rumination occurs only in cows and children with mental retardation. G&h when diagnosing patients, how is rumination differentiated from other disorders, such as vomiting syndromes and gastroesophageal reflux disease? Nt patients with rumination are frequently misdiagnosed, and they often misinterpret their own symptoms, with their descriptions of their symptoms being quite different than what is actually happening. Classically, a patient with rumination presents with “recurrent vomiting. ” other patients present with “regurgitation” or a label of gastroesophageal reflux disease. Unless a detailed history is obtained, the physician will likely conclude that the patient has gastroparesis or another vomiting syndrome (eg, an eating disorder), and he or she will prescribe diagnostic tests and treatments for vomiting that will not help the patient. Therefore, it is important to ask patients to explain their symptoms in a little more detail. viagra for sale without a prescription viagra for sale viagra without a doctor prescription viagra online buy generic viagra cheap viagra pills online viagra online cheap viagra online howtosmudge.com/pjn-cheap-generic-viagra-online-bn/ viagra for sale When patients with rumination are asked to specify what they mean by “vomiting,” they often state that food or fluid that is undigested and tastes good comes back up into their mouth, and they either spit it out or reswallow it. Patients often assume that vomiting refers to gastric contents coming up. However, in the classic presentation of rumination, these patients are not experiencing actual vomiting. Vomiting requires forceful ejection of stomach contents; when vomiting, patients cannot retain food in their mouth, as they can with rumination. G&h are any diagnostic tests helpful for establishing diagnoses in more difficult cases? Nt the key to diagnosing rumination is obtaining a detailed history. In the absence of a good history, there is an excellent chance that the diagnosis will be missed. In this patient population, there are no routine diagnostic tests of any value. An esophagogastroduode-noscopy may be performed to make sure that the patient does not have esophagitis (which may be identified in a subset of patients); likewise, 24-hour esophageal ph testing may be used to identify pathologic acid reflux (which may be identified in approximately 50% of patients, typically in the first hour after a meal, with rapid changes in ph reflecting food reswallowing). However, these tests diagnose gastroesophageal reflux disease, not rumination, and these patients will not respond to antireflux therapy. In contrast, gastroduodenal manometry is of diagnostic value in rumination, but it is invasive. Rumination (tall r waves) can be seen in gastric manometry tracings in approximately 40% of patients. However, this test is not routinely administered; it is a specialized test that is avail able in very few centers. G&h how effective is treatment for rumination? Nt because rumination is likely behavioral in origin, it can be unlearned, which is the most effective met.



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