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Rome IV diagnostic criteria for rumination syndrome
Symptom-based diagnosis of rumination syndrome.
Rome IV diagnostic criteria for rumination syndrome
Persistent or recurrent regurgitation of recently ingested food into the mouth, with subsequent spitting or remastication and swallowing
Regurgitation is not preceded by retching
Symptoms present for the last 3 months, with onset at least 6 months before diagnosis
Not fully explained by another medical condition (e.g. gastroparesis, achalasia, gastro-oesophageal reflux) and does not occur exclusively during another functional GI disorder
ResultCriteria not met
At least one required criterion is not fulfilled; rumination syndrome cannot be diagnosed by Rome IV criteria and alternative diagnoses (e.g. gastroparesis, achalasia, cyclic vomiting) should be considered.
When to use
- Distinguishing rumination syndrome from gastro-oesophageal reflux, gastroparesis, or eating disorders in patients with effortless post-prandial regurgitation.
Formula
Diagnosis requires ALL of: (1) persistent/recurrent regurgitation of recently ingested food with spitting or remastication and swallowing, (2) regurgitation not preceded by retching, (3) symptoms for the last 3 months with onset ≥6 months before diagnosis, (4) not better explained by another condition and not occurring exclusively during another functional GI disorder.
Pearls and pitfalls
- Regurgitation is typically effortless and unaccompanied by nausea; it often stops once the refluxate becomes acidic.
- High-resolution oesophageal manometry with impedance can confirm the characteristic rise in intragastric pressure when the diagnosis is uncertain.