Standard medical treatments fail up to 40% of children who report reflux symptoms. Adults with Proton Pump Inhibitors refractory Gastro-Esophageal Reflux Disease (GERD) exhibit rumination syndrome in 20% of cases. The treatment of GERD and rumination varies greatly. The purpose of this study was to detect rumination syndrome in children with chronic GERD symptoms based on a unique pattern on impedance-pH monitoring. The characteristics of impedance-pH monitoring were compared between children with rumination syndrome, as determined by high-resolution manometry impedance (HRM/Z), children with GERD, children with an alternative diagnosis, and children who tested negative for ruminating on HRM/Z. The characteristics that identify the ruminating group was discovered and combined into a scoring system, which was blindly used on the second sample of children with refractory GERD to define its sensitivity and specificity. Rumination syndrome affects 44 percent of children with refractory GERD. Children with rumination syndrome had a high incidence of postprandial nonacid reflux events, as well as a very positive symptom-reflux relationship study. A score of 2 out of 3 differentiates children with rumination syndrome with a sensitivity of 75% and specificity of 80%.

Children with rumination syndrome have a specific pattern of impedance-pH monitoring that allows them to be differentiated from children with refractory GERD. Using a simple scoring system during impedance-pH analysis might lead to earlier identification of rumination syndrome in children.