Spandana Alluri, MD1, Allen Yudovich, MD2, Brian Ginnebaugh, MD2 1Henry Ford Health, West Bloomfield, MI; 2Henry Ford Health, Detroit, MI Introduction: Rumination syndrome (RS) is an underrecognized functional gastrointestinal (GI) disorder that can symptomatically mimic other conditions, including dysphagia, regurgitation, and vomiting. We present the case of a patient who initially appeared to have dysphagia, but was ultimately diagnosed with rumination syndrome following extensive evaluation. The patient was successfully treated with diaphragmatic breathing therapy.
Case Description/
Methods: A 55 year old female presented for dysphagia to solids and liquids for greater than 6 months, described as sensation of food getting stuck in mid chest. She also reported regurgitation, often after meals and occasionally delayed forup to 3 hours following eating. Initial endoscopy revealed mild distal esophageal ring stenosis with biopsy showing lymphocytic esophagitis. She was initiated on a proton pump inhibitor (PPI) with minimal symptomatic relief. Subsequent esophagram showed evidence of esophageal dysmotility, though high-resolution manometry was normal, ruling out motility disorders. Due to severe symptom burden, repeat EGD was performed with empiric balloon dilation despite minimal stenosis, which yielded no symptomatic benefit. Notably, repeat biopsies showed no evidence of lymphocytic esophagitis. Due to suspicion for RS, high resolution manometry with 24hr pH and impedance was done, which showed several prominent retrograde reflux events followed by antegrade flow, consistent with RS. She was initiated on baclofen, GI-focused psychotherapy, and diaphragmatic breathing exercises with near-complete symptom resolution. At 6 month follow-up, she remained asymptomatic off all pharmacotherapy. Discussion: This case highlights the importance of considering rumination syndrome in patients presenting with apparent dysphagia, particularly when symptoms involve effortless regurgitation of undigested food shortly after eating. It also showcases the potential role of high resolution manometry with impedance to help confirm diagnosis of RS. This case further illustrates the importance of diligent evaluation without anchoring-bias, as seen by the histologic resolution of lymphocytic esophagitis, despite persistent symptoms. Finally, it reinforces the effectiveness of behavioral therapy in managing rumination syndrome and value of multidisciplinary approach to treatment in these patients.
Disclosures: Spandana Alluri indicated no relevant financial relationships. Allen Yudovich indicated no relevant financial relationships. Brian Ginnebaugh: Ardelyx – Speakers Bureau.
Spandana Alluri, MD1, Allen Yudovich, MD2, Brian Ginnebaugh, MD2. P0824 - Rumination Syndrome Presenting as Dysphagia: A Case Highlighting the Role of High Resolution Manometry With Impedance, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.
