Guideline sources The following summarized guidelines for the evaluation and management of rumination syndrome (RS) are prepared by our editorial team based on guidelines from the British Society of Gastroenterology (BSG 2019) and the American Gastroenterological Association (AGA 2018). 1 2 Guidelines 1. Screening and diagnosis Diagnosis: As per BSG 2019 guidelines, consider diagnosing RS clinically on the basis of a typical history. B As per AGA 2018 guidelines, suspect RS in patients with consistent postprandial regurgitation (often labeled as having refractory gastroesophageal reflux or vomiting). B Show 2 more 2. Diagnostic investigations Postprandial high-resolution impedance manometry: https://web.pathway.md/diseases/recpSxi7DTxoSuhpH 1/2 6/24/23, 2:57 PM Rumination syndrome Pathway As per BSG 2019 guidelines, consider obtaining high-resolution manometry with impedance after a test meal to identify diagnostic features of RS, if the diagnosis is unclear, the patient needs convincing of the diagnosis, or objective evidence is required before therapy. B As per AGA 2018 guidelines, consider obtaining objective testing for RS with postprandial high- resolution esophageal impedance manometry to support the diagnosis of RS. C 3. Medical management Baclofen: consider offering baclofen at a dose of 10 mg TID as a reasonable option in patients with refractory RS. C 4. Nonpharmacologic interventions Diaphragmatic breathing: Offer diaphragmatic breathing with or without biofeedback as first-line therapy in all patients with RS. B Consider providing instructions for effective diaphragmatic breathing by speech therapists, psychologists, gastroenterologists, and other health practitioners familiar with the technique. C References 1. Magnus Halland, John Pandolfino, Elizabeth Barba. Diagnosis and Treatment of Rumination Syndrome. Clin Gastroenterol Hepatol. 2018 Oct;16 10 1549 1555. Open 2. Nigel J Trudgill, Daniel Sifrim, Rami Sweis et al. British Society of Gastroenterology guidelines for oesophageal manometry and oesophageal reflux monitoring. Gut. 2019 Oct;68 10 1731 1750. Open https://web.pathway.md/diseases/recpSxi7DTxoSuhpH 2/2