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In most patients, the diagnosis of rumination syndrome is made by satisfying Rome criteria and taking a careful history. Indeed, treatment may be initiated on this basis. In some situations, however, objective testing is needed to confirm the diagnosis [14]. The most reliable test is performing an impedance manometry with a meal. During this study, standard baseline measurements are made fasting in addition to determining basal gastric pressure. After a meal is consumed with the catheter in place, postprandial gastric and LES basal pressures are calculated. A period of approximately 30 minutes is maintained to observe for rumination events. These events are characterized by rapid rises in gastric pressure (termed an “R” wave), reduction of LES pressure, and the appearance of gastric content entering the distal esophagus as shown in Figure 4.1. One of the keys to this testing is establishing optimal conditions by which the patient will ruminate during the study by meal choice and timing. Other testing that has been used to diagnose rumination syndrome includes gastroduodenal manometry or EMG used to detect contraction of the abdominal musculature during rumination. These tests, however, are only available in a few specialized centers. Finally, from a practical point of view, most patients will have undergone endoscopy and/or esophagography prior to manometry. These tests are normal in patients with rumination syndrome but can be useful in assessing the possibility for other disorders.

Figure 4.1 Manometric pattern of rumination syndrome. Arrow indicates periods of increased gastric pressurization. The last arrow on the right demonstrates a rumination event with gastric pressurization associated with retrograde flow on impedance (purple) proximal to the lower esophageal sphincter.