The Long-Term Benefit of Behavioral Intervention for Rumination Syndrome

Columbus, OH — August 2017

A number of publications demonstrate that behavioral treatment strategies for adolescents with rumination syndrome have short-term success — in many cases, rumination symptoms diminish and supplemental nutrition becomes unnecessary.

But a recent study from the inpatient Rumination Syndrome Program at Nationwide Children’s Hospital shows that immediate success can continue for a year or more for patients.

“We found that nearly 80 percent of our study group had one or more days with no rumination, and while 55 percent of those patients entered our program requiring supplemental nutrition, only 15 percent needed it a year or more after discharge,” says Carlo Di Lorenzo, MD, chief of Gastroenterology, Hepatology and Nutrition at Nationwide Children’s, medical director of the rumination program and an author of the study. “That reinforces just how important behavioral strategies can be.”

The study, published in the Journal of Pediatric Gastroenterology and Nutrition, examined surveys completed by 47 adolescent patients. The patients had a mean age of 15.9 years, and 87 percent were female. The surveys asked questions about progress since discharge and included the Children’s Somatization Inventory (to measure presence and severity of somatic symptoms) and the Pediatric Quality of Life Inventory.

A large majority of patients had some time with no rumination, and 19 percent were symptom-free for six months or longer. A total of 40 percent reported a reduction in rumination frequency since discharge, and 27.7 percent said they had an improvement in frequency and intensity. Somatic symptoms and quality of life also significantly improved for patients.

Behavioral interventions for this population may include habit reversal, relaxation, diaphragmatic breathing and biofeedback, says Anthony Alioto, PhD, a member of the Section of Psychology at Nationwide Children’s, clinical director of the rumination program and a study author. The interdisciplinary inpatient program at Nationwide Children’s allows for the use of these strategies and others.

“We are able to understand rumination syndrome for these patients from a bio-psychosocial perspective,” Dr. Alioto says. “Many domains of functioning are affected for these adolescents, and we need to consider all of them to best help our patients.”

Alioto A, Di Lorenzo C. Long-term follow-up of adolescents treated for rumination syndrome in an inpatient setting. Journal of Pediatric Gastroenterology and Nutrition.  2017 May 12. [Epub ahead of print]