Original articleAlimentary tractBiofeedback-Guided Control of Abdominothoracic Muscular Activity Reduces Regurgitation Episodes in Patients With Rumination
Section snippets
Participants
Patients with clinical criteria for rumination1 underwent a clinical work-up to rule out relevant organic diseases and gastrointestinal manometry. Gastrointestinal manometry was continuously performed for 3 hours fasting, during ingestion of a solid-liquid meal (450 Kcal), and 2 hours postprandially by using a standard technique, as previously described12 (Supplementary Material). Patients were provided with an event marker to signal any episode of regurgitation of ingested food back into the
Patient Demographics
Twenty-eight patients (17 women, 11 men; age range, 14–76 years) were included in the study. The mean body mass index was 22 ± 2 kg/m2; 8 patients (42%) reported weight loss in the previous year, and 7 of them had body mass index below normal range (defined as <20.1 kg/m2 in men and <18.7 kg/m2 in women). At recruitment, mean duration of symptoms was 4.9 ± 1.2 years. Eleven patients reported a sudden onset of symptoms. Overall, half of the patients reported an association of the onset of
Discussion
Our data indicate that rumination is produced by an unperceived somatic response to food ingestion that disrupts abdominal accommodation and that can be effectively corrected by biofeedback-guided control of abdominothoracic muscular activity.
The abdomen and thorax constitute separate compartments of the abdominothoracic cavity, with the diaphragm operating as a dynamic boundary so that changes in one compartment have an immediate repercussion on the other. Our data indicate that regurgitation
Acknowledgments
The authors thank Prof R. Merletti and Dr A. Bottin for help in setting up the electromyography system; Maite Casaus, Purificación Rodriguez, and Anna Aparici for technical support; Gloria Santaliestra for secretarial assistance; and Christine O'Hara for English editing of the manuscript.
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2020, Cognitive and Behavioral PracticeCitation Excerpt :Given our findings, it is possible that for some individuals, creating a competing response to abdominal wall contraction is not the mechanism of change in treatment. Diaphragmatic breathing is purportedly used as an action incompatible with abdominal wall contraction to disrupt the habitual reaction to food stimuli (Barba et al., 2015). However, although we hypothesized the primary maintenance pathway for KG’s regurgitations was habitual abdominal wall contraction, diaphragmatic breathing appeared to have little to no effect.
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Current address for Dr Burri: Department of Internal Medicine, Stadspital Triemli, Zürich, Switzerland.
Conflicts of interest The authors disclose no conflicts.
Funding Supported in part by the Spanish Ministry of Education (Dirección General de Investigación, SAF 2009-07416) and European Community (project OASIS, QLRT-2001-00218); Ciberehd is funded by the Instituto de Salud Carlos III. Dr Burri was supported by grants from the Freiwillige Akademische Gesellschaft (Basel, Switzerland) and the Gottfried und Julia Bangerter-Rhyner-Stiftung (Bern, Switzerland). English editing of the manuscript was funded by SAF 2009-07416.