Stationary or ambulatory high-resolution manometry (HRM) and intraluminal pH-impedance monitoring can evaluate oesophageal function and monitor gastroesophageal reflux. These tests can be used to diagnose gastroesophageal reflux disease, achalasia, rumination syndrome, aerophagia, and supragastric belching¹.

We did a retrospective review of case notes of the patients diagnosed with functional vomiting or rumination who were referred for High-Resolution Oesophageal Manometry (HRM) from December 2021 until December 2022 to understand the role of oesophageal function tests. We collected data on patient demographics, results of the Oesophageal function test (OFT) and clinical outcomes.

During this period, 19 patients were referred for HRM and 10 of them were for functional vomiting or rumination. These patients were needing intense medical input in the form of prolonged hospital stays, recurrent presentations in the emergency department, or significant weight loss to need enteral feeding support. The age of these patients ranged between 10–16 years (mean 12.5 years), 3 were boys and 7 were girls.

4/10 patients had abnormal manometry results in the form of increased gastric pressure (3/4) and increased pressurisation in the mid-oesophagus (1/4). 5/10 patients had abnormal results on the pH/impedance study. Among them, 2/5 patients showed increased supine acid exposure, 1/5 patients showed raised acid exposure with sipping of low pH fluid and 2/5 patients showed aerophagia before vomiting.

3/10 patients showed symptom co-relation with the results. 4/10 patients who were diagnosed with rumination syndrome either clinically or with OFT had biofeedback. On follow-up over variable periods, 3 patients continued to have ongoing vomiting, 3 patients were on nasogastric feeds, 2 patients were on nasojejunal feeds and 2 patients had recovered completely with no requirement of nutrition support.

To the best of our knowledge, no studies are looking at the benefits of OFT in children with functional vomiting. Although rumination is a clinical diagnosis, high-resolution oesophageal impedance manometry is considered as a gold standard to support the diagnosis but not in clinical management². Our study shows that OFT can help to reassure patients/parents and also provide useful techniques via biofeedback to overcome their symptoms. It also guided our clinical psychologists in their approach to these patients. We conclude that these tests are beneficial if used in the right context. However, we understand there are limitations in our study being a retrospective study with a low sample size. A larger prospective study can help to better understand the role of OFT in this group of patients.

References

1. Chahuan J, King P, Monrroy H. Rumiation syndrome. Review article. Journal of Gastroenterology of Mexico. 2021;86:163–171.

2. Lennep M, Leijdekkers M. Clinical experience with performing esophageal function testing in children. JPGN 2021;72:226–231.