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Erschienen in:

15.01.2019 | short communication

Rumination syndrome after esophagectomy

verfasst von: Daniele Bernardi, MD, Emanuele Asti, MD, Lavinia Barbieri, MD, Luigi Bonavina, MD, FACS

Erschienen in: European Surgery | Ausgabe 2/2019

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Summary

Background

Gastric conduit dysfunction after esophagectomy is a disabling condition that may require revisional surgery. Rumination syndrome is an uncommon and poorly recognized functional foregut disorder of unknown etiology characterized by effortless oral regurgitation of recently ingested food. Rumination is associated with increased intragastric pressure generated by an unconscious mechanism eliciting contraction of the abdominal wall and relaxation of the diaphragm. Rumination syndrome after esophagectomy has not been previously reported in the literature.

Methods

Two female patients were referred for inability to eat and weight loss due to severe food regurgitation following esophagectomy and gastric conduit replacement. Their previous medical and psychiatric history was apparently unremarkable. Symptoms occurred within the first postoperative year and progressively worsened. High-dose proton pump inhibitors, erythromycin, metoclopramide, antidepressant medications, pneumatic pyloric dilatation, and laparoscopic pyloromyotomy failed to relieve symptoms, and both patients eventually required permanent tube jejunostomy for nutritional support. Subsequently, thoracoscopic implant of a neurostimulator and a laparoscopic Roux-en-Y gastrojejunostomy were performed and failed in both patients.

Results

All medical and surgical attempts to relieve symptoms were clinically unsuccessful in these patients in whom radiological and endoscopic investigations did not demonstrate trans-diaphragmatic hernia or mechanical obstruction of the gastric conduit. Eventually, the diagnosis of rumination syndrome was made based on the Rome IV criteria.

Conclusion

In the absence of anatomical or other functional abnormalities of the gastric conduit, revisional surgery is contraindicated; rather, the diagnosis of rumination syndrome should be considered. The role of behavioral therapy integrated with diaphragmatic breathing training and biofeedback should be investigated in these patients.
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Metadaten
Titel
Rumination syndrome after esophagectomy
verfasst von
Daniele Bernardi, MD
Emanuele Asti, MD
Lavinia Barbieri, MD
Luigi Bonavina, MD, FACS
Publikationsdatum
15.01.2019
Verlag
Springer Vienna
Erschienen in
European Surgery / Ausgabe 2/2019
Print ISSN: 1682-8631
Elektronische ISSN: 1682-4016
DOI
https://doi.org/10.1007/s10353-018-0567-4

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