Rumination Syndrome

Rumination Syndrome: Overview

Alternative names: Rumination Disorder

Rumination syndrome is being increasingly recognized.  The behavior consists of daily, effortless regurgitation of undigested food within minutes of starting or completing ingestion of a meal.  The regurgitated food is then either re-chewed and swallowed, or spat out.

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Although this is seen as normal behavior in many animals such as cows, regurgitation of food by humans is not a normal practice.  Because the regurgitated food has not been digested yet, it is not acidic and tastes 'normal'.

Rumination syndrome can sometimes be confused with other eating disorders such as GERD (gastroesophageal reflux disease), gastroparesis, or bulimia nervosa.  Although rumination syndrome is a disease in itself, it can in some cases be associated with these other disorders.

Incidence; Causes and Development; Contributing Risk Factors

In the past the syndrome was mostly diagnosed in infants and people with developmental disabilities but in recent years the condition has become more known and medical practitioners now frequently diagnose it in older children, teenagers and adults as well.

Statistics about the number of people suffering from rumination syndrome are unavailable but its occurrence is seen as relatively rare.

The exact cause of rumination syndrome is unknown but it is believed to be an unconscious learned disorder involving the voluntary relaxation of the diaphragm; it is not a conscious decision but happens more as a subconscious reflex response.

Symptoms can occur during childhood after the age of three months due to lack of infant stimulation, neglect or a stressful family situation.  The syndrome can also surface during adulthood.

Factors that could increase the risk of rumination syndrome include:

  • Acute illness
  • Mental illness
  • Psychiatric disturbances
  • Major surgeries
  • Stress

Signs and Symptoms

It is important to note that rumination is different from vomiting: Instead of digested, acidic fluid being brought up, rumination instead refers to undigested, non-acidic food that is being rechewed and eaten again by the sufferer.  Symptoms may also include:

  • Weight loss or difficulty keeping weight up
  • Bad breath
  • Tooth decay
  • Indigestion and stomach aches
  • Dry mouth and lips

Symptoms must be present for at least one month for it to be described as rumination syndrome.

Diagnosis and Tests

Rumination syndrome is often misdiagnosed as other vomiting disorders and it is therefore critical to ask the patient the right questions to obtain a correct diagnosis based on his or her medical history.  Finding out if the food still tastes good when it comes back up is a primary indication that rumination syndrome is at play.  Whereas vomited food is acidic and does not taste good because it has been partially digested, regurgitated food is undigested and therefore still palatable.

Other physical causes must also be ruled out before a final rumination syndrome diagnosis can be made.  These include:

Rumination syndrome is included in the differential diagnosis of persistent nausea and vomiting, even though it differs from both.

Treatment and Prevention

If physical causes of rumination disorder have been ruled out, it can be treated with various breathing exercises and habit reversal therapy.  Patients should be familiarized with the signs and situations when rumination is likely to occur and then taught how to respond to it by using certain diaphragmatic breathing techniques that would prevent regurgitation; regurgitation can not take place when the diaphragm is relaxed.

Other ways to treat rumination disorder include:

  • Reducing stress and distractions during meals
  • Focusing on posture during and after meals
  • Psychotherapy

No medications are currently available to treat rumination syndrome effectively.

Prognosis

Rumination syndrome does not cause any severe physical damage to the human body but can cause problems with the esophagus and result in unhealthy weight loss if left untreated.

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