{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T18:31:36Z","timestamp":1790620296289,"version":"4.1.0"},"reference-count":23,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2016,12,21]],"date-time":"2016-12-21T00:00:00Z","timestamp":1482278400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100006823","name":"Boston Children's Hospital","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100006823","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["R01 DK097112\u201001"],"award-info":[{"award-number":["R01 DK097112\u201001"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Neurogastroenterology Motil"],"published-print":{"date-parts":[[2017,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>The differential diagnosis of intractable reflux in children includes rumination syndrome, but confirming the diagnosis using antroduodenal manometry is invasive, is costly, and requires anesthesia. High\u2010resolution esophageal manometry with impedance (<jats:styled-content style=\"fixed-case\">HRM<\/jats:styled-content>\u2010<jats:styled-content style=\"fixed-case\">MII<\/jats:styled-content>) overcomes these limitations, and the goal of this study is to validate the use of <jats:styled-content style=\"fixed-case\">HRM<\/jats:styled-content>\u2010<jats:styled-content style=\"fixed-case\">MII<\/jats:styled-content> as a diagnostic tool for rumination and to describe the subtypes of pediatric rumination.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We reviewed the <jats:styled-content style=\"fixed-case\">HRM<\/jats:styled-content>\u2010<jats:styled-content style=\"fixed-case\">MII<\/jats:styled-content> tracings of 21 children presenting with symptoms of intractable reflux in whom rumination was being considered. Patients underwent a standard and post\u2010prandial <jats:styled-content style=\"fixed-case\">HRM<\/jats:styled-content>\u2010<jats:styled-content style=\"fixed-case\">MII<\/jats:styled-content>. Peak intraluminal esophageal pressures, baseline gastric and thoracic pressures, and the timing of the R wave relative to <jats:styled-content style=\"fixed-case\">LES<\/jats:styled-content> relaxations and bolus flow were recorded. Chi\u2010square analyses were used for comparison of proportions and means were compared using <jats:italic>t<\/jats:italic>\u2010tests or non\u2010parametric equivalent.<\/jats:p><\/jats:sec><jats:sec><jats:title>Key Results<\/jats:title><jats:p>Forty\u2010one (55.5%) primary and 33 (44.5%) secondary rumination episodes were seen. Three types of primary rumination were identified: i) <jats:styled-content style=\"fixed-case\">LES<\/jats:styled-content> relaxation without retrograde flow preceding the R wave (51% of episodes); ii) <jats:styled-content style=\"fixed-case\">LES<\/jats:styled-content> relaxation after the R wave (20% of episodes); and iii) R waves with no <jats:styled-content style=\"fixed-case\">LES<\/jats:styled-content> relaxation (29% of episodes). Eleven patients had rumination episodes with a peak gastric pressure &lt;30\u00a0mm Hg. A total of 44 (60%) rumination episodes occurred during the standard <jats:styled-content style=\"fixed-case\">HRM<\/jats:styled-content>\u2010<jats:styled-content style=\"fixed-case\">MII<\/jats:styled-content>, and 30 (40%) occurred during or after the meal.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions &amp; Inferences<\/jats:title><jats:p><jats:styled-content style=\"fixed-case\">HRM<\/jats:styled-content>\u2010<jats:styled-content style=\"fixed-case\">MII<\/jats:styled-content> can accurately diagnose rumination in children. We identify three types of primary rumination which may provide insight into therapeutic response.<\/jats:p><\/jats:sec>","DOI":"10.1111\/nmo.12998","type":"journal-article","created":{"date-parts":[[2016,12,21]],"date-time":"2016-12-21T22:56:45Z","timestamp":1482361005000},"source":"Crossref","is-referenced-by-count":42,"title":["Pediatric rumination subtypes: A study using high\u2010resolution esophageal manometry with impedance"],"prefix":"10.1111","volume":"29","author":[{"given":"R.","family":"Rosen","sequence":"first","affiliation":[{"name":"Center for Motility and Functional Gastrointestinal Disorders Division of Gastroenterology, Hepatology and Nutrition Boston Children's Hospital  Boston MA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L.","family":"Rodriguez","sequence":"additional","affiliation":[{"name":"Center for Motility and Functional Gastrointestinal Disorders Division of Gastroenterology, Hepatology and Nutrition Boston Children's Hospital  Boston MA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S.","family":"Nurko","sequence":"additional","affiliation":[{"name":"Center for Motility and Functional Gastrointestinal Disorders Division of Gastroenterology, Hepatology and Nutrition Boston Children's Hospital  Boston MA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2016,12,21]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2016.02.015"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11894-014-0398-9"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2005.08.063"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2036.2011.04584.x"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2011.10.042"},{"issue":"100","key":"e_1_2_10_7_1","first-page":"e101","article-title":"Biofeedback\u2010guided control of abdominothoracic muscular activity reduces regurgitation episodes in patients with rumination","volume":"13","author":"Barba E","year":"2015","journal-title":"Clin Gastroenterol Hepatol"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2982.2009.01431.x"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.111.1.158"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2982.2008.01230.x"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2982.2002.00347.x"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/apt.12148"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1038\/ajg.2013.428"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1097\/MCG.0000000000000142"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2982.2011.01812.x"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1542-3565(05)00854-2"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.3109\/00365521.2011.605467"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1111\/nmo.12477"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1152\/ajpgi.1998.275.2.G314"},{"key":"e_1_2_10_20_1","first-page":"G624","article-title":"Human lower esophageal sphincter pressure response to increased intra\u2010abdominal pressure","volume":"258","author":"Mittal RK","year":"1990","journal-title":"Am J Physiol"},{"key":"e_1_2_10_21_1","first-page":"1621","article-title":"Voluntary induction of transient lower esophageal sphincter relaxations in an adult patient with the rumination syndrome","volume":"85","author":"Smout AJ","year":"1990","journal-title":"Am J Gastroenterol"},{"key":"e_1_2_10_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2012.09.006"},{"key":"e_1_2_10_23_1","doi-asserted-by":"publisher","DOI":"10.1097\/MPG.0b013e3182a2747b"},{"key":"e_1_2_10_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpeds.2006.05.029"}],"container-title":["Neurogastroenterology &amp; 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