Rumination syndrome and eosinophilic esophagitis in children: Defining the relationship

OBJECTIVES: While rumination syndrome (RS) and eosinophilic esophagitis (EoE) can share overlapping symptoms, their association remains unclear. Our objective was to explore the relationship between RS and EoE and understand the clinical course of children with both conditions. METHODS: We conducted a retrospective cohort study of children with RS and EoE evaluated at our institution from 2016 to 2023. Patient characteristics, symptoms, treatments, and outcomes were compared. RESULTS: Among 230 children with RS, 22 (10%) had both RS and EoE (77% male, median age 18 years). Sixteen (70%) were first diagnosed with EoE, two (9%) with RS, and four (18%) concurrently. Most (91%) presented with regurgitation; 64% reported dysphagia at some point. EoE treatment led to mucosal remission in 73% and improved dysphagia in 41%, but 86% continued to experience regurgitation. RS treatment, including behavioral therapy and baclofen, improved or resolved regurgitation in 64%. Peak eosinophil counts were similar in children with and without dysphagia (43 vs. 51 eos/HPF, p = 0.589). Those without dysphagia responded better to RS treatment (67% vs. 22%), though the difference was not statistically significant. Among those diagnosed with EoE first, RS diagnosis occurred after a median of 15.4 months. CONCLUSIONS: EoE was more prevalent among children with RS than in the general population. Regurgitation seemed more responsive to RS treatment than EoE treatment. In patients with EoE and persistent regurgitation, RS should be considered, especially when symptoms persist despite EoE remission.