Skip to main content
SpringerLink
Log in

Effective treatment of ruminations with Nissen fundoplication

  • Published:
Journal of Gastrointestinal Surgery

Abstract

Rumination is a syndrome characterized by the effortless regurgitation of recently ingested food. It has been linked to severe medical and psychosocial conditions including malnutrition, aspiration pneumonia, and complete social withdrawal. Psychotherapy, the current treatment modality for rumination, may improve symptoms but requires significant motivation and is rarely curative. We hypothesized that a complete fundoplication would eliminate, or at least impair, the ability to regurgitate gastric contents through the esophagogastric junction. We performed a Nissen fundoplication in five patients with a classic history of rumination. In all cases, symptoms had been resistant to medical and psychiatric intervention prior to fundoplication. Formal preoperative testing included esophageal manometry, 24-hour pH monitoring, endoscopy, and upper gastrointestinal barium swallow studies. All patients reported their primary symptom to be effortless recurrent postprandial regurgitation for 1 to 2 hours after meals consistent with rumination. Four (80%) of the five patients had low resting lower esophageal sphincter pressures with evidence of gastroesophageal reflux disease on 24-hour pH monitoring. All patients reported complete cessation of ruminating behavior after Nissen fundoplication. We report, for the first time, complete elimination of rumination symptoms after a Nissen fundoplication. Although further trials are needed to confirm our results, we recommend considering a Nissen fundoplication for treatment of rumination refractory to behavioral and medical interventions.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Fredericks DW, Carr JE, Williams WL. Overview of the treatment of rumination disorder for adults in a residential setting. J Behav Ther Exp Psychiatry 1998;29:31–40.

    Article  PubMed  CAS  Google Scholar 

  2. Johnston JM, Greene KS. Relation between ruminating and quantity of food consumed. Ment Retard 1992;30:7–11.

    PubMed  Google Scholar 

  3. Rogers B, Stratton P, Victor J, Kennedy B, Andres M. Chronic regurgitation among persons with mental retardation: A need for combined medical and interdisciplinary strategies. Am J Ment Retard 1992;96:522–527.

    PubMed  CAS  Google Scholar 

  4. Singh NN. Rumination. In Ellis NR, ed. International Review of Research in Mental Retardation, vol 10. San Diego: Academic Press; 1981, pp 139–182.

    Google Scholar 

  5. O’Brien MD, Bruce BK, Camilleri M. The rumination syndrome: Clinical features rather than manometric diagnosis. Gastroenterology 1995;108:1024–1029.

    Article  PubMed  CAS  Google Scholar 

  6. Levine DF, Wingate DL, Pfeffer JM, Butcher P. Habitual rumination: A benign disorder. Br Med J (Clin Res Ed) 1983;287:255–256.

    CAS  Google Scholar 

  7. Konarski EA, Favell JE. Manual for the Assessment and Treatment of Behavior Disorders of People With Mental Retardation. North Carolina: Western Carolina Center Foundation, 1992.

    Google Scholar 

  8. Shay SS, Johnson LF, Wong RK, et al. Rumination, heartburn, and daytime gastroesophageal reflux. A case study with mechanisms defined and successfully treated with biofeedback therapy. J Clin Gastroenterol 1986;8:115–126.

    Article  PubMed  CAS  Google Scholar 

  9. Amarnath RP, Abell TL, Malagelada JR. The rumination syndrome in adults. A characteristic manometric pattern. Ann Intern Med 1986;105:513–518.

    PubMed  CAS  Google Scholar 

  10. Breumelhof R, Smout AJ, Depla AC. The rumination syndrome in an adult patient. J Clin Gastroenterol 1990; 12:232–234.

    Article  PubMed  CAS  Google Scholar 

  11. Smout AJ, Breumelhof R. Voluntary induction of transient lower esophageal sphincter relaxations in an adult patient with the rumination syndrome. Am J Gastroenterol 1990; 85:1621–1625.

    PubMed  CAS  Google Scholar 

  12. Thumshirn M, Camilleri M, Hanson RB, et al. Gastric mechanosensory and lower esophageal sphincter function in rumination syndrome. AmJ Physiol 1998;275:314–321.

    Google Scholar 

  13. Hasler WL. New insights into the pathogenesis of rumination: What’s coming up next. Gastroenterology 1999;116:1006–1008.

    Article  PubMed  CAS  Google Scholar 

  14. Pursnani KG, Sataloff DM, Zayas F, Castell DO. Evaluation of the antireflux mechanism following laparoscopic fundoplication. BrJ Surg 1997;84:1157–1161.

    Article  CAS  Google Scholar 

  15. Martinez de Haro L, Parrilla Paricio P, Ortiz Escandell MA, et al. Antireflux mechanism of Nissen fundoplication. A manometric study. ScandJ Gastroenterol 1992;27:417–420.

    CAS  Google Scholar 

  16. Fisher RS, Malmud LS, Lobis IF, Maier WP. Antireflux surgery for symptomatic gastroesophageal reflux: Mechanism of action. Am J Dig Dis 1978;23:152–160.

    Article  PubMed  CAS  Google Scholar 

  17. Ireland AC, Holloway RH, Toouli J, Dent J. Mechanisms underlying the antireflux action of fundoplication. Gut 1993; 34:303–308.

    Article  PubMed  CAS  Google Scholar 

  18. Johnsson F, Holloway RH, Ireland AC, et al. Effect of funoplication on transient lower oesophageal sphincter relaxation and gas reflux. Br J Surg 1997;84:686–689.

    Article  PubMed  CAS  Google Scholar 

  19. Clouse RE, Richter JE, Heading RC, et al. Functional esophageal disorders. Gut 1999;45(Suppl 2):1131–1136.

    Google Scholar 

  20. Soykan I, Chen J, Kendall BJ, McCallum RW. The rumination syndrome: Clinical and manometric profile, therapy, and long-term outcome. Dig Dis Sci 1997;42:1866–1872.

    Article  PubMed  CAS  Google Scholar 

  21. Tamburrino MB, Campbell NB, Franco KN, Evans CL. Rumination in adults: Two case histories. Int J Eat Disord 1995;17:101–104.

    Article  PubMed  CAS  Google Scholar 

  22. Fairburn CG, Cooper PJ. Rumination in bulimia nervosa. BrMedJ (Clin Res Ed) 1984;288:826–827.

    CAS  Google Scholar 

  23. Larocca FE, Della-Fera MA. Rumination: Its significance in adults with bulimia nervosa. Psychosomatics 1986;27:209–212.

    PubMed  CAS  Google Scholar 

  24. Eckern M, Stevens W, Mitchell J. The relationship between rumination and eating disorders. Int J Eat Disord 1999;26:414–419.

    Article  PubMed  CAS  Google Scholar 

  25. Malcolm A, Thumshirn MB, Camilleri M, Williams DE. Rumination syndrome. Mayo Clin Proc 1997;72:646–652.

    Article  PubMed  CAS  Google Scholar 

  26. Parry-Jones B. Merycism or rumination disorder. A historical investigation and current assessment. Br J Psychiatry 1994;165:303–314.

    PubMed  CAS  Google Scholar 

  27. Brown WR. Rumination in the adult. A study of two cases. Gastroenterology 1968;54:933–939.

    PubMed  CAS  Google Scholar 

  28. Reynolds RP, Lloyd DA. Manometric study of a ruminator. J Clin Gastroenterol 1986;8:127–130.

    Article  PubMed  CAS  Google Scholar 

  29. Breumelhof R, Fellinger HW, Vlasblom V, et al. Dysphagia after Nissen fundoplication. Dysphagia 1991;6:6–10.

    Article  PubMed  CAS  Google Scholar 

  30. Kamolz T, Bammer T, Pointner R. Predictability of dysphagia after laparoscopic Nissen fundoplication. Am J Gastroenterol 2000;95:408–414.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Swallowing Center, Department of Surgery, University of Washington, Seattle, Washington

    Brant K. Oelschlager M.D., Maren M. Chan M.D., Thomas R. Eubanks D.O., Charles E. Pope II M.D. & Carlos A. Pellegrini M.D.

Authors
  1. Brant K. Oelschlager M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Maren M. Chan M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Thomas R. Eubanks D.O.
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Charles E. Pope II M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Carlos A. Pellegrini M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Brant K. Oelschlager M.D..

Additional information

Supported in part by a grant from U.S. Surgical, a division of Tyco, Inc.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Oelschlager, B.K., Chan, M.M., Eubanks, T.R. et al. Effective treatment of ruminations with Nissen fundoplication. J Gastrointest Surg 6, 638–644 (2002). https://doi.org/10.1016/S1091-255X(01)00068-3

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1016/S1091-255X(01)00068-3

Key words

Search

Navigation