Rumination syndrome in a child with severe chronic encephalopathy

Abstract

Introduction: rumination syndrome (RS) is an uncommon functional gastrointestinal disorder. It is characterized by repeated regurgitation of recently ingested food, which does not occur during sleep and is not preceded by nausea. It occurs in the absence of an underlying organic disease to account for the symptoms.
Objectives: to describe the diagnostic and therapeutic management of RS in a child with severe chronic encephalopathy.
Case presentation: an 8-year-old male with severe static (non-progressive) chronic encephalopathy and clinical dysphagia. He demonstrated normal growth until age 6. One year prior to the consultation, he developed frequent postprandial regurgitations without retching or nausea, accompanied by rumination. Symptoms resolved during sleep. Physical examination revealed an emaciated appearance, reduced muscle mass, and depleted subcutaneous fat. Body mass index (BMI) was 11,5 < P5 (z-score = -4.0). Esophagogastroduodenoscopy (EGD) demonstrated grade III gastroesophageal reflux. Daytime oral feeding was fractionated, and complete formula was administered via continuous nocturnal gastroclysis; omeprazole was initiated, and a therapeutic trial of baclofen was conducted. The patient showed favorable progress and was discharged after 25 days with gained weight, receiving oral nutrition.
Discussion: RS is a poorly recognized entity. Its diagnosis is primarily clinical and one of exclusion. High-resolution esophageal manometry combined with impedance testing is the gold standard when the clinical presentation is ambiguous. An interdisciplinary and multimodal therapeutic approach is required. Cognitive-behavioral therapy cannot be used in children with severe neurological impairment. Treatment with baclofen represents a viable therapeutic option. Careful follow-up planning is essential to monitor treatment response and potential adverse effects.