What Is Rumination Syndrome?
Rumination syndrome is a disorder in which recently swallowed food is effortlessly spit back up or regurgitated. This food is usually undigested and people with this condition either spit it out or chew it and swallow it again. It is typical to experience this regurgitation of food every day at multiple meals within 30 minutes of eating .
Extensive testing may be completed to rule out related conditions and for proper treatment to begin. Specific treatments include behavioral modification through breathing exercises and possible medication.
You should discuss your symptoms with your primary care physician.
How common is rumination syndrome?
Symptoms that always occur with rumination syndrome:
Symptoms that never occur with rumination syndrome:
- Vomiting (old) blood or passing tarry stools
Rumination Syndrome Symptoms
A few main symptoms occur in those with rumination syndrome as well as a few others that present in some cases. Regurgitation typically occurs 10 to 30 minutes after consumption of food, but can persist for several hours afterward, followed by the remaining symptoms.
The main symptoms of rumination syndrome involve the regurgitation of food and accompanying abdominal pain.
- Regurgitation of food: Some people spit out the food when it is regurgitated while others chew it and swallow it again. People who re-swallow their regurgitation have reported that the food tastes normal because it was recently consumed and undigested by stomach acid. The regurgitation episodes are not preceded by retching or gagging, as would be seen in vomiting.
- Abdominal pain: This pain is usually not as severe as pain associated with vomiting, and may be mild to moderate. It is most likely caused by the contraction of the abdominal muscles necessary to move food back up the esophagus.
The following symptoms occur in some people with rumination syndrome.
- Constipation: This is thought to be due to an irregular diet because of regurgitated meals. The feelings of constipation and bloating are often due to stool moving too slowly through the colon. With inconsistently digested meals, it takes substantially longer to form stool.
- Weight loss: Studies have shown that weight loss occurs in about 20 to 40 percent of people with rumination syndrome . This weight loss, that is likely unintentional, is due to the regurgitation of meals.
- Psychiatric conditions: Research has shown that there is overlap among people with rumination and psychiatric conditions . Rumination syndrome co-occurs in people with OCD, depression , anxiety, PTSD, and ADHD.
Rumination Syndrome Causes
The exact cause behind rumination is unknown, however, it may be helpful to understand normal digestion and the process of rumination.
- How food travels to the stomach: When food is swallowed, it moves down the esophagus and then through a tight opening between the esophagus and the stomach, called the gastroesophageal sphincter, where it then passes into the stomach.
What keeps food in the stomach: The purpose of the sphincter is to prevent food that has already made its way into the stomach from moving back up into the esophagus.
What occurs in rumination: Muscle contractions in the abdomen must occur with enough force from below to overcome the resistance of the sphincter and allow swallowed food to move back up the esophagus.
Who is most likely to be affected
Studies are limited on the prevalence of rumination syndrome in the general population, but it has been estimated to be in the range of 0.8 percent of adults. Other people who can be affected by rumination include:
- People with fibromyalgia: This is a chronic pain syndrome that has links to rumination as high as eight percent [5,7].
- People with eating disorders: These individuals can have rates of rumination syndrome as high as eight percent [6,7].
Treatment Options and Prevention for Rumination Syndrome
Treating rumination syndrome first involves a careful diagnosis with likely rounds of testing to rule out similar diagnoses. There is no definitive treatment for rumination syndrome and management is centered around behavioral modification . Modifications include breathing techniques and treatment of any coexisting psychiatric conditions.
Diagnosis of rumination syndrome follows criteria outlined in a set of guidelines called Rome IV . To meet these criteria, your physician will determine if you meet the following factors.
- Persistent or recurrent regurgitation:"Persistent or recurrent regurgitation of recently ingested food into the mouth with subsequent spitting or re-mastication and swallowing" must occur.
- An absence of retching: If retching is present or the prior stipulation is not true, the diagnosis cannot be made .
- Other factors: Your physician may also consider the absence of nausea and recognizable food upon regurgitation.
There is no definitive test to diagnose rumination syndrome. Many people undergo extensive GI testing to rule out other causes of regurgitation . These tests include:
- Barium swallow: A barium swallow is a test that uses a non-harmful, swallowed material and X-ray imaging to look at the esophagus, stomach, and upper small intestine.
- Upper endoscopy: An upper endoscopy is a procedure in which a GI physician passes a camera through your throat to look at your esophagus and stomach while you are under anesthesia.
- Gastric emptying: A gastric emptying study is used to determine the rate at which food is moving through your stomach to assess for overly slow digestion.
- Gastroduodenal manometry: A gastroduodenal manometryis used to measure variations in the pressure within the abdomen.
Presence of similar conditions
The tests discussed above can help rule out other diagnoses that can have similar symptoms to rumination syndrome.These include:
- Gastroparesis (overly slow digestion)
- Blockage of the intestine
- Eating disorders: This especially includes bulimia nervosa, which must also be excluded before the diagnosis of rumination syndrome.
The specific breathing exercise used to manage rumination syndrome is called diaphragmatic breathing.
- Details: This technique is designed to decrease intra-abdominal pressure so that it cannot amount enough force to push food back through the sphincter of the gastroesophageal junction.
- Hand placement: To perform this maneuver, you will be told to place one hand on your abdomen and one hand on your chest.
- Breathing: When breathing, you should feel the movement of your hand on your stomach but minimal movement of the hand on your chest.
- Efficacy: Studies have shown that this technique is effective in controlling regurgitation .
If you do not have success with diaphragmatic breathing, you may be recommended medical therapy.
- Type: Baclofen is a type of medication called a GABA agonist. Its use in rumination syndrome is intended to increase the strength of the sphincter at the gastroesophageal junction.
- Efficacy: There is mixed data regarding the efficacy of this therapy, so it is typically reserved for people who do not have success with more conservative approaches.
- Side effects: Baclofen also has side effects including drowsiness, lightheadedness, and confusion.
When to Seek Further Consultation for Rumination Syndrome
You should seek medical attention any time you begin regurgitating food or your child is regurgitating for unknown reasons.
If you begin regurgitating food
If this occurs either intentionally or unintentionally, you should consult your physician.
If you are a parent of a child who is regurgitating
Parents of infants regurgitating food should seek care from a physician to determine the severity of the condition.
Questions Your Doctor May Ask to Determine Rumination Syndrome
To diagnose this condition, your doctor would likely ask about the following symptoms and risk factors.
- Do food or drinks get stuck when you swallow?
- Have you or do you suffer from gastroesophageal reflux disease (GERD)?
- Do you have heartburn?
- Are you retching or dry heaving (vomiting but without anything coming up)?
- Have you experienced any nausea?
The above questions are also covered by our A.I. Health Assistant.
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- Disney B, Trudgill N. Managing A Patient with Rumination. Frontline Gastroenterology. 2013;4(3):232-236. BMJ.
- Pace S. Rumination Associated with Several Forms of Mental Illness. PsyPost.org. PsyPost.org Link. Published July 13, 2016.
- Law BM. Probing the Depression-Rumination Cycle. American Psychological Association. AMA Link. Published November 2005.
- Malin K, Littlejohn GO. Rumination Modulates Stress and Other Psychological Processes in Fibromyalgia. European Journal of Rheumatology. 2015;2(4):143-148. EJR.
- Rawal A, Park RJ, Williams JMG. Rumination, Experiential Avoidance, and Dysfunctional Thinking in Eating Disorders. Behaviour Research and Therapy. 2010;48(9):851-859. PubMed Link.
- Halland M, Talley NJ, Friedman LS, Grover S. Rumination Syndrome. UpToDate. UpToDate Link. Published June 16, 2018.
- Zeevenhooven J, Koppen IJN, Benninga MA. The New Rome IV Criteria for Functional Gastrointestinal Disorders in Infants and Toddlers. Pediatric Gastroenterology, Hepatology & Nutrition. 2017;20(1):1-13. Pubmed Link.
- Chial HJ, Camilleri M. A Twenty-One-Year-Old College Student with Postprandial Regurgitation and Weight Loss. Clinical Gastroenterology and Hepatology Journal. 2006;4(11):1314-1317. CGHJ Link.
- Rumination Disorder. National Institutes of Health: Genetic and Rare Diseases Information Center (GARD). GARD Link. Published April 23, 2015.
- Halland M, Parthasarathy G, Bharucha AE, Katzka DA. Diaphragmatic Breathing for Rumination Syndrome: Efficacy and Mechanisms of Action. Neurogastroenterology & Motility. 2016;28(3):384-391. PubMed Link.