The Unusual Patient in a Reflux Center: Belching, Rumination, Somatization as Pitfalls of Patient Selection for Anti-Reflux Surgery.

BACKGROUND: Behaviorally conspicuous "odd" patients have a considerable potential to complicate selection for anti-reflux surgery. This is mainly due to a certain overlap of diseases, like GERD, disorders of gut-brain Interaction, like rumination syndrome, and somatization representing an individually increased perception of bodily complaints. Therefore, some basic insight is required to address these patients properly. Somatization and somatoform disorders are found in patients who report an unusually high number of bodily complaints. They complain about (much) more symptoms than expected from patients with "simple" reflux disease. These patients can be identified by specific instruments, lists of symptoms or also quality-of-life indices. When identified properly, these patients can also benefit from anti-reflux surgery. Other patients suffer from disorders, recently termed as disorders of the gut-brain interaction like belching disorders or rumination syndrome. In the few patients with rumination syndrome, a relevant overlap of at least 10% with gastroesophageal reflux disease exists and must be diagnosed. Apart from reflux disease, rumination syndrome, and supragastric belching are behavioral entities which have recently become amenable to cognitive based mental training. In addition, awareness techniques are advisable (awareness-based cognitive mental stress reduction techniques also exist as digital applications for mobile phones, i.e., for breathing modification techniques).

KEY MESSAGES: Somatization and rare disorders like belching and rumination syndrome, which are part of the disorders of brain gut interaction, should be recognized and considered in patient selection for anti-reflux surgery.