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Chahuan J, Rey P, Monrroy H. Rumination syndrome. A review article. Rev Gastroenterol Mex (Engl Ed) 2021; 86:163-171. [PMID: 33602544 DOI: 10.1016/j.rgmx.2020.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 11/11/2020] [Accepted: 11/13/2020] [Indexed: 02/07/2023]
Abstract
Rumination syndrome is a functional gastrointestinal disorder characterized by effortless postprandial regurgitation of ingested food into the mouth. An unperceived postprandial contraction of the abdominal wall could be a key mechanism. In those patients, retrograde flow of the ingested gastric content into the mouth is produced due to a simultaneous combination of elevated intra-abdominal pressure and negative intrathoracic pressure. The estimated prevalence is around 2% in the general adult population. The main clinical characteristics include: a) early postprandial regurgitation, b) the effortlessly regurgitated material is similar to the ingested food, c) the regurgitated material is spit out or swallowed again. The clinical diagnosis of rumination syndrome relies on the clinical criteria. High resolution esophageal manometry, ideally including impedance monitoring, can be an important adjunct for making the clinical diagnosis. Its management is based on instruction as to the nature of the pathology, education in postprandial diaphragmatic breathing, and the assessment of possible psychiatric comorbidity. Baclofen use is reserved for second-line treatment in patients with refractory symptoms.
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Affiliation(s)
- J Chahuan
- Departamento de Gastroenterología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - P Rey
- Departamento de Gastroenterología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; Laboratorio de Fisiología Digestiva, Red de Salud UC-Christus, Santiago, Chile
| | - H Monrroy
- Departamento de Gastroenterología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; Laboratorio de Fisiología Digestiva, Red de Salud UC-Christus, Santiago, Chile.
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Pribic T, Vilaseca H, Nieto A, Hernandez L, Monrroy H, Malagelada C, Accarino A, Roca J, Azpiroz F. Meal composition influences postprandial sensations independently of valence and gustation. Neurogastroenterol Motil 2018; 30:e13337. [PMID: 29575437 DOI: 10.1111/nmo.13337] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 02/13/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND Palatability of meals with identical composition has been shown to influence postprandial sensations. Our aim was to determine to what extent meal composition influences postprandial sensations independently of palatability. METHODS Randomized, crossover, double-blind trial comparing the postprandial responses to a low-fat vs a high-fat test meal, with the same physical and organoleptic characteristics (taste, smell, texture, color, and temperature). The test meal consisted in 150 g hummus containing either 17.7 g fat (low-fat) or 22.3 g fat (high-fat), 19.8 g toasts, 120 mL water and 50 g apple puree. In 12 non-obese healthy men, palatability, homeostatic sensations (hunger/satiety, fullness) and hedonic sensations (digestive well-being, mood) were measured on 10 cm scales before and during the 60-min postprandial period. Comparisons between meals were performed with a two-way repeated measures ANCOVA with premeal data as co-variate. KEY RESULTS Both test meals were rated equally palatable (palatability scores 3.8 ± 0.3 low-fat, 3.3 ± 0.2 high-fat; P = .156). As compared to the high-fat meal, the low-fat meal induced more satisfaction (meal effect on well-being F(1,21) = 4.92; P = .038) and tended to improve mood (meal effect F(1,21) = 3.02; P = .064), and this was associated with a non-significant decrease in satiety (meal effect F(1,21) = 2.29; P = .145) and fullness (meal effect F(1,21) = 1.57; P = .224). CONCLUSIONS AND INFERENCES The composition of meals with equal palatability influences postprandial satisfaction, even without significant impact on homeostatic sensations, although an effect on homeostatic sensations has not been excluded. These conditioning factors may have clinical implications in patients with impaired meal tolerance or meal-related symptoms.
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Affiliation(s)
- T Pribic
- Digestive System Research Unit, University Hospital Vall d'Hebron, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Ciberehd), Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - A Nieto
- Digestive System Research Unit, University Hospital Vall d'Hebron, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Ciberehd), Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - L Hernandez
- Digestive System Research Unit, University Hospital Vall d'Hebron, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Ciberehd), Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - H Monrroy
- Digestive System Research Unit, University Hospital Vall d'Hebron, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Ciberehd), Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - C Malagelada
- Digestive System Research Unit, University Hospital Vall d'Hebron, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Ciberehd), Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - A Accarino
- Digestive System Research Unit, University Hospital Vall d'Hebron, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Ciberehd), Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - J Roca
- El Celler de Can Roca, Girona, Spain
| | - F Azpiroz
- Digestive System Research Unit, University Hospital Vall d'Hebron, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Ciberehd), Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
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Cisternas D, Scheerens C, Omari T, Monrroy H, Hani A, Leguizamo A, Bilder C, Ditaranto A, Ruiz de León A, Pérez de la Serna J, Valdovinos MA, Coello R, Abrahao L, Remes-Troche J, Meixueiro A, Zavala MA, Marin I, Serra J. Anxiety can significantly explain bolus perception in the context of hypotensive esophageal motility: Results of a large multicenter study in asymptomatic individuals. Neurogastroenterol Motil 2017; 29. [PMID: 28480513 DOI: 10.1111/nmo.13088] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 03/14/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND Previous studies have not been able to correlate manometry findings with bolus perception. The aim of this study was to evaluate correlation of different variables, including traditional manometric variables (at diagnostic and extreme thresholds), esophageal shortening, bolus transit, automated impedance manometry (AIM) metrics and mood with bolus passage perception in a large cohort of asymptomatic individuals. METHODS High resolution manometry (HRM) was performed in healthy individuals from nine centers. Perception was evaluated using a 5-point Likert scale. Anxiety was evaluated using Hospitalized Anxiety and Depression scale (HAD). Subgroup analysis was also performed classifying studies into normal, hypotensive, vigorous, and obstructive patterns. KEY RESULTS One hundred fifteen studies were analyzed (69 using HRM and 46 using high resolution impedance manometry (HRIM); 3.5% swallows in 9.6% of volunteers were perceived. There was no correlation of any of the traditional HRM variables, esophageal shortening, AIM metrics nor bolus transit with perception scores. There was no HRM variable showing difference in perception when comparing normal vs extreme values (percentile 1 or 99). Anxiety but not depression was correlated with perception. Among hypotensive pattern, anxiety was a strong predictor of variance in perception (R2 up to .70). CONCLUSION AND INFERENCES Bolus perception is less common than abnormal motility among healthy individuals. Neither esophageal motor function nor bolus dynamics evaluated with several techniques seems to explain differences in bolus perception. Different mechanisms seem to be relevant in different manometric patterns. Anxiety is a significant predictor of bolus perception in the context of hypotensive motility.
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Affiliation(s)
- D Cisternas
- Universidad del Desarrollo, Facultad de Medicina, Clínica Alemana de Santiago, Santiago, Chile
| | - C Scheerens
- Translational Research Center for Gastrointestinal Disorders, KU Leuven, Leuven, Belgium
| | - T Omari
- Human Physiology, Medical Science and Technology, School of Medicine, FlindersUniversity, Adelaide, SA, Australia
| | - H Monrroy
- Department of Gastroenterology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - A Hani
- San Ignacio Hospital, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - A Leguizamo
- San Ignacio Hospital, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - C Bilder
- Neurogastroenterology, School of Medicine, Universitary Hospital FundacionFavaloro, Buenos Aires, Argentina
| | - A Ditaranto
- Neurogastroenterology, School of Medicine, Universitary Hospital FundacionFavaloro, Buenos Aires, Argentina
| | - A Ruiz de León
- Hospital Clínico San Carlos, Universidad Complutense, Madrid, Spain
| | | | - M A Valdovinos
- Motility Lab, Department of Gastroenterology, National Institute of Medical Sciences and Nutrition Salvador Zubirán, Mexico City, Mexico
| | | | - L Abrahao
- University Hospital Clementino Fraga Filho, Rio de Janeiro, Brazil
| | - J Remes-Troche
- Digestive Physiology and Motility Lab, Medical BiologicalResearchInstitute, Veracruzana University, Veracruz, Mexico
| | - A Meixueiro
- Digestive Physiology and Motility Lab, Medical BiologicalResearchInstitute, Veracruzana University, Veracruz, Mexico
| | - M A Zavala
- Digestive Physiology and Motility Lab, Medical BiologicalResearchInstitute, Veracruzana University, Veracruz, Mexico
| | - I Marin
- Motility and Functional Gut Disorders Unit, Department of Medicine, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Autonomous University of Barcelona, University Hospital Germans TriasiPujol, Badalona, Spain
| | - J Serra
- Motility and Functional Gut Disorders Unit, Department of Medicine, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Autonomous University of Barcelona, University Hospital Germans TriasiPujol, Badalona, Spain
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