Protocol and Outcome Evaluation of Comprehensive Outpatient Treatment of Adolescent Rumination Syndrome.

Abstract

Rumination syndrome (RS) is an increasingly recognized functional gastrointestinal condition with limited treatment research. Current treatment recommendations emphasize diaphragmatic breathing (DB), despite limited outcomes, and the most robust results have originated from inpatient treatment models. This paper described the protocol for Comprehensive Behavioral Treatment for Rumination Syndrome (CBT-R) utilized in an outpatient setting and evaluation of preliminary outcomes. The CBT-R protocol is described in detail, grounded in behavioral theory and phased treatment approach to symptom elimination. The treatment is evaluated via a retrospective case series design of pediatric patients (aged 8-18) with a primary diagnosis of RS treated in an outpatient setting by a pediatric psychologist. Twenty-eight patients met inclusion criteria and are included in intent-to-treat analysis, with 23 patients evaluated for outcomes (47.8% female, M age = 14.3; SD = 2.8). Sample included 17.4% with comorbid psychiatric diagnosis and 43.5% with comorbid medical diagnoses. Outcome results demonstrate improvement for a majority of patients (87.0%), with most demonstrating complete resolution of symptoms (73.9%). Treatment length varied significantly, ranging from 1 to 22 visits (M = 4.8, SD = 5.4) and was complicated by necessary admission or supplemental nutrition in 21.7% of patients. Psychological factors were related to poor treatment outcomes and longer treatment duration. CBT-R results in positive treatment outcomes for majority of patients, with most patients demonstrating complete resolution of symptoms, providing a superior outpatient treatment option for some pediatric patients. Sample characteristics challenge previous understanding of RS as female dominated and with high levels of psychiatric comorbidity.