Award: Presidential Poster Award
Alejandro Robles, MD, Yehudi A. Romero, MD, Eric Tatro, MD, Hugo Quezada, BS, Richard McCallum, MD
Texas Tech University Health Sciences Center, Paul L. Foster School of Medicine, El Paso, TX
Introduction: Rumination syndrome (RS) is a functional gastrointestinal disorder that is characterized by effortless postprandial regurgitation, usually preceded by belching, and accompanied by epigastric abdominal wall pain and 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 the more standard approach of diaphragmatic breathing/relaxation techniques (DB/RT) for the treatment of RS, as well as highlight the clinical aspects of this entity.
Methods: Patients referred to an academic motility center for vomiting of unknown origin were prospectively identified. Those who fulfilled the Rome IV criteria for RS received hands-on instructions/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 three months of this therapy.
Results: A total of 44 patients, 35 women; mean age 40.4 [range 20-71] were identified and completed the treatment protocol. Mean time from onset of symptoms to diagnosis was 36.0 months [range 6-180], weight loss ranged from 1.4 – 39.5 kg., six required a jejunostomy feeding tube (J-tube), and one was receiving total parenteral nutrition (TPN). 65.9% had a history of anxiety and/or depression, and 65.9% reported the onset of symptoms were chronologically related to an inciting event/psychological stressor. Moreover, half of the patients were taking opioid medications for abdominal wall pain at the time of initial evaluation (Table 1). 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, all six patients with a J-tube were weaned off, and the patient on TPN was transitioned to a J-tube. Additionally, 81.8% of patients initially taking opioid medications were successfully tapered off by the time of follow-up (Table 2).
Discussion: The combination of a TCA with DB/RT is an effective treatment modality for the management of RS as it addresses the underlying factors identified in this entity.
Citation: Alejandro Robles, MD, Yehudi A. Romero, MD, Eric Tatro, MD, Hugo Quezada, BS, Richard McCallum, MD. P1254 - THE COMBINATION OF A TRICYCLIC ANTIDEPRESSANT AND DIAPHRAGMATIC BREATHING IS AN EFFECTIVE TREATMENT FOR RUMINATION SYNDROME. Program No. P1254. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.