Rumination syndrome

Overview

Rumination syndrome is a condition in which someone repeatedly regurgitates undigested or partially digested food from the stomach. The regurgitated food is then chewed again and swallowed or spit out. People with rumination syndrome don't try to regurgitate food. It happens without any effort.

Because the food hasn't yet been digested, it reportedly tastes like regular food and isn't acidic like vomit. Rumination typically happens at every meal, soon after eating.

It's not clear how many people have this condition. Treatment may include behavioral therapy or medicine. Behavioral therapy typically involves teaching people to breathe from the diaphragm.

Symptoms

Symptoms of rumination syndrome include:

• Effortless regurgitation, typically within minutes of eating.
• Belly pain or pressure relieved by regurgitation.
• A feeling of fullness.
• Nausea.
• Losing weight without trying.

Rumination syndrome isn't usually associated with retching.

When to see a doctor

Consult a healthcare professional if you or your child often regurgitates food.

Causes

The exact cause of rumination syndrome isn't clear. But it appears to be caused by an increase in abdominal pressure.

Rumination syndrome is often confused with bulimia nervosa, gastroesophageal reflux disease (GERD) and gastroparesis. Some people have rumination syndrome linked to a rectal evacuation disorder. A rectal evacuation issue involves pelvic floor muscles that don't work together correctly, which leads to ongoing constipation.

The condition has long been known to happen in infants and people with developmental disabilities. It's now clear that the condition isn't related to age, as it can happen in children, teens and adults. Rumination syndrome is more likely to happen in people with anxiety, depression or other psychiatric disorders.

Complications

Complications of rumination syndrome may include:

• Unhealthy weight loss.
• Malnutrition.
• Worn teeth.
• Bad breath.
• Embarrassment.
• Social isolation.

Untreated, rumination syndrome can damage the tube between the mouth and stomach, called the esophagus.

Diagnosis

To diagnose rumination syndrome, a healthcare professional asks about current symptoms and takes a medical history. This first examination, combined with observing behavior, is often enough to diagnose rumination syndrome.

Sometimes, tests such as high-resolution esophageal manometry and impedance measurement are used to confirm the diagnosis. This testing shows whether there is increased pressure in the abdomen. It also can provide an image of the irregular function for use in behavioral therapy.

Other tests that may be used to rule out other possible causes of your or your child's symptoms include:

• Upper endoscopy. This test allows a close look at the esophagus, stomach and upper part of the small intestine to rule out any obstruction. A small tissue sample called a biopsy may be removed for further study.
• Gastric emptying. This procedure can measure how long it takes food to empty from the stomach. Another version of this test also can measure how long it takes food to travel through the small intestine and colon.

Treatment

Treatment for rumination syndrome takes place after ruling out other disorders and depends on age and cognitive ability.

Behavior therapy

Habit-reversal behavior therapy is used to treat people without developmental disabilities who have rumination syndrome. First, you learn to recognize when rumination happens. When rumination starts, you use the abdominal muscles to breathe in and out. This technique is called diaphragmatic breathing. Diaphragmatic breathing prevents abdominal contractions and regurgitation.

Biofeedback is part of behavior therapy for rumination syndrome. During biofeedback, imaging can help you or your child learn diaphragmatic breathing skills to counteract regurgitation.

For infants, treatment usually focuses on working with parents or caregivers to change the infant's environment and behavior.

Medicine

Some people with rumination syndrome may benefit from treatment with medicine that helps relax the stomach after eating.

If frequent rumination is damaging the esophagus, proton pump inhibitors such as esomeprazole (Nexium) or omeprazole (Prilosec) may be prescribed. These medicines can protect the lining of the esophagus until behavior therapy reduces the frequency and severity of regurgitation.

Preparing for an appointment

You may start by seeing your or your child's primary healthcare professional. Or you may be referred immediately to a doctor who specializes in digestive disorders, called a gastroenterologist.

Here's some information to help you get ready for your appointment.

What you can do

When you make the appointment, ask if there's anything that needs to be done in advance, such as fasting before a specific test. Make a list of:

• Symptoms, including any that seem unrelated to the reason for the appointment.
• Key personal information, including major stresses, recent life changes and family medical history.
• All medications, vitamins or other supplements you or your child takes, including the doses.
• Questions to ask the healthcare professional.

Take a family member or friend along, if possible, to help you remember the information you're given.

For rumination syndrome, some basic questions to ask include:

• What's the most likely cause of these symptoms?
• Are there other possible causes?
• Are any tests needed?
• Is this likely temporary or long lasting?
• What treatment do you recommend?
• Are there any alternatives to the primary approach you're suggesting?
• Are any dietary restrictions recommended?
• Do you have any brochures or other printed material about this condition? What websites do you recommend?

What to expect from your doctor

You'll likely be asked a few questions during the appointment, such as:

• When did the symptoms begin?
• Do symptoms occur with every meal?
• How severe are the symptoms?
• Does anything make your or your child's symptoms better?
• Does anything seem to worsen the symptoms?

What you can do in the meantime

Chewing gum may help ease some rumination syndrome symptoms for some people.