What is rumination syndrome?
Rumination syndrome is a rare disorder. Food you have recently swallowed comes back up into your mouth (regurgitated). Usually, the food is not digested. People either spit the food out or chew it and swallow it again.
People with rumination syndrome typically regurgitate undigested food within 10 to 30 minutes. This can happen only with particular foods or with many foods. Sometimes it even happens on an empty stomach, in which case only acid is brought back up.
The main symptom is regurgitation. You may also have abdominal pain as your abdominal wall contracts and brings up food. Other symptoms may include constipation, weight loss, and bad breath. It can often lead to anxiety around food and mealtimes.
Rumination syndrome is sometimes confused with other conditions like gastroesophageal reflux disease (GERD) or bulimia nervosa, an eating disorder. Often people go through multiple tests before the correct diagnosis is made.
Treatment includes behavioral approaches like breathing exercises, biofeedback, cognitive behavioral therapy and meditation.
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Most common symptoms
Rumination syndrome is not vomiting. There is no nausea, vomiting, or retching. Usually, there is an “urge,” which then leads to contraction of the abdominal muscles, propelling food into the mouth. Once this is done, the urge goes away. —Dr. Shria Kumar
The main symptom of rumination syndrome is regurgitating undigested food. Some people spit out the food; others chew it and swallow it again. People who re-swallow say that the food tastes normal because it has not yet been digested by stomach acid.
Regurgitation usually happens 10 to 30 minutes after eating. But it can happen several hours afterward. It can also happen on an empty stomach.
There is no nausea or vomiting, and people with rumination syndrome do not “retch.” Some people have an “urge” before it happens. Once the food comes up, the urge goes away. Some people also have stomach pain, which is from the abdominal muscles contracting (squeezing) and moving food back up the esophagus.
- Regurgitation of food
Other symptoms you may have
- Stomach pain, as your abdominal wall contracts.
- Urge to regurgitate, sometimes in response to particular foods.
- Constipation if you are not digesting your meals or your diet is irregular.
- Bad breath and tooth decay from the food and acid in your mouth.
- Weight loss: About 20% to 40% of people with rumination syndrome lose weight, probably when they are not trying to.
If you or your child are regurgitating food, see your primary care doctor. The doctor may refer you to a gastroenterologist (a specialist in the digestive system), who will do tests to rule out other conditions, like GERD, a blockage, and eating disorders.
Your doctor will first ask questions to be sure that you:
- Are repeatedly regurgitating food you just ate.
- Are not retching, as you would if you were vomiting. If you are vomiting, this is a sign that it may be something else.
- Are not having nausea. Nausea suggests you don’t have rumination syndrome.
- Cannot recognize the food you regurgitate because food is generally regurgitated undigested.
There is no single test to diagnose rumination syndrome, but you may have tests to rule out other causes. These tests can include:
- Barium swallow: You are given a barium drink, and your doctor uses an X-ray to follow the barium as it moves through your esophagus, stomach, and intestine.
- Upper endoscopy: Your doctor passes a tube with a camera down your throat to look at your esophagus and stomach while you are under anesthesia.
- Gastric emptying: This shows how quickly food is moving through your stomach, to look for overly slow digestion.
- Gastroduodenal manometry: This test measures changes in the pressure within your abdomen.
What causes rumination syndrome?
I want to know what happens after—do they spit it out or chew it and redigest it. Importantly, I want to ensure this is not an “organic” problem (that there is no blockage or some reason food is coming back up) and I want to ensure that this is not an eating disorder. —Dr. Kumar
Doctors don’t know exactly what causes rumination syndrome. It sometimes follows a viral illness, a stressful incident, or an injury, but there isn’t always a clear trigger.
Normally, when food is swallowed, it moves down the esophagus and through a tight opening between the esophagus and the stomach, called the gastroesophageal sphincter. Then it passes into the stomach.
The sphincter prevents food in the stomach from moving back up into the esophagus.
In people with rumination syndrome, muscle contractions in the abdomen that are stronger than the sphincter muscle push food back up the esophagus.
Rumination syndrome is very rare. But certain groups are more likely to have it:
- Infants and children.
- People with fibromyalgia, a chronic pain syndrome.
- People with certain psychiatric conditions: obsessive-compulsive disorder (OCD), depression, anxiety, post-traumatic stress disorder (PTSD), or attention-deficit/hyperactivity disorder (ADHD).
- People with developmental disabilities.
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Treatment of rumination syndrome
The diagnosis of rumination syndrome is not easy to make, and it’s not easy to treat. Largely, because we do not understand a lot about it. If you are diagnosed with rumination syndrome, there will be a period of trial and error to identify what therapies work best for you. —Dr. Kumar
There is no single cure for rumination syndrome. The main way to treat it is by changing certain behaviors. These include breathing techniques and biofeedback. Cognitive behavioral therapy and meditation are also helpful.
Treating psychiatric conditions, if you have any, may also help. Your doctor may also prescribe medication.
For babies or people with developmental disabilities, rumination is often caused by a particular food. Identifying and avoiding that food may help.
Diaphragmatic breathing training helps relax your abdominal muscles and lowers the pressure in your abdomen. This reduces the pressure that pushes food back up.
To learn how to do it, place one hand on your abdomen and one hand on your chest. When breathing, you should feel your hand on your stomach move up and down, but very little movement of the hand on your chest.
If breathing exercises aren’t helping, your doctor may also recommend medication:
- Baclofen can increase the strength of the sphincter, making it harder for food to come back up. Your doctor may try this if other treatments haven’t worked. Side effects can include drowsiness, lightheadedness, and confusion.
- Proton pump inhibitors like omeprazole (Prilosec) or esomeprazole (Nexium) help protect the lining of your esophagus from damage.
- Antidepressants can help with both depression and anxiety, which often occur with rumination syndrome.
Male, age 85. For the past year I have been expelling food particles after every meal. It starts almost immediately after I eat. I have no pain and it is not as though I am throwing up. Just small pieces that come up for at least 90 minutes. Occasionally, I have some small throw up but this is the exception. I have seen a Gastro doctor 3 to 4 times. He said he cannot figure out what is going on. I have had my esophagus stretched two times in three years and that has not helped. I swallowed barium and the doctor could see that the food I eat is going to my stomach and not catching on any sack. And that the barium and food almost immediately starts to return back up to my mouth. None of this feels uncomfortable at all but it is somewhat disgusting as it is every meal.