DDSEP® 8 Quick Quiz

November 2018 Question 2

Publish date: November 1, 2018

An 18-year-old female college student has a 6-month history of vomiting, with associated 15-pound weight loss during this time period. Her medical history is significant for a gastroenteritis about 1 year ago and surgery for pyloric stenosis as an infant. She has no psychiatric history. Current medication includes an oral contraceptive. She describes the vomiting episodes as effortless regurgitation of food within 30 minutes of a meal. She also reswallows the food if she is in public. The vomiting occurs with almost every meal, either solid or liquid. An upper endoscopy, 4-hour gastric emptying test by scintigraphy and basic blood work are performed. Upper endoscopy is normal with no retained food. She cannot complete the gastric emptying test due to vomiting of the radiolabeled test meal. Her blood work demonstrates a normal fasting blood glucose and complete blood count.

What is the most likely etiology of her symptoms?

Recurrent small bowel obstruction

Adaptation to the belch reflex

Idiopathic gastroparesis

Bulimia

Rationale

The patient clinically has rumination syndrome or an adaptation to the belch reflex, with effortless regurgitation, with voluntary re-swallowing of the regurgitated material. Recurrent small bowel obstruction is less likely as the pattern of regurgitation is with almost every meal, within minutes and does not follow the typical pattern of a bowel obstruction. Idiopathic gastroparesis is less likely as the pattern of regurgitation is not consistent with gastroparesis, in addition she is not diabetic.

She has no psychiatric history and there are no findings suggestive of bulimia.

Reference

1. Marrero F.J., Shay S.S. Regurgitation and rumination. In: Richter, J.E. Castell, D.O., eds. The Esophagus, 5th ed. West Sussex, England: Wiley-Blackwell; 2012.

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November 2018 Question 1