10 Facts About Rumination Syndrome

Many disorders can affect the digestive system. Some are physiological, while others are physical conditions with a strong psychological component. Rumination syndrome is one of the latter. People with this condition unintentionally regurgitate undigested food. They then either rechew it and swallow, or spit it out. Luckily, this rare condition is fully treatable.

Regurgitation Occurs Automatically

In rumination syndrome, regurgitation is not intentional. It typically occurs within ten minutes to one hour of eating, at which point the previously swallowed food comes back up into the mouth. Individuals with rumination syndrome typically report that food comes up in the same state it went down; that is, undigested and without any vomit-like taste.

Symptom: Abdominal Pain

In people with rumination syndrome, abdominal pain sometimes occurs after eating. It often comes with a feeling of fullness and in some cases, individuals also experience nausea after eating. After regurgitating food, these symptoms usually go away within minutes, only returning after another meal.

Symptom: Bad Breath

Constant regurgitation of food, whether from rumination syndrome or other disorders such as gastroesophageal reflux disease (GERD), can lead to halitosis or bad breath. Bacteria from food that sits in the mouth after regurgitation, combined with stomach acids that work their way up through the esophagus, can cause this symptom. By brushing teeth and flossing frequently, people with rumination syndrome may be able to combat halitosis.

Symptom: Weight Loss and Malnutrition

On top of abdominal discomfort and halitosis, people with rumination syndrome might experience weight loss, malnutrition, dehydration, and electrolyte imbalances. These symptoms tend to appear in more advanced cases and primarily affect those who prefer to spit out regurgitated food rather than re-chew and swallow it.

The Cause Isn’t Fully Known

The exact cause of rumination syndrome remains unknown but there are theories about it. Some physicians and researchers suspect this disorder is strongly associated with emotional stress, depression, and other psychiatric conditions. Others have found that it can occur after an individual endures a physical injury or viral illness that affects the abdomen. Regardless of the initial cause, most people continue to experience their food coming back up even after their initial issues resolve.

Commonly Misdiagnosed

There isn’t much information available about rumination syndrome and because the regurgitation is often confused with vomiting or acid reflux, it’s not uncommon for this condition to be misdiagnosed. A person with rumination syndrome might be misdiagnosed with GERD, gastroparesis, or cyclic vomiting syndrome, in which individuals experience nausea and vomiting at regular intervals.

It’s Generally Behavioral

Triggers for rumination syndrome include illness and injury, but the condition is behavioral in nature. Typically, once regurgitation begins, the individual unconsciously associates it with feelings of physical relief and after some time, it becomes a learned behavior. The sooner treatment begins, the more likely it is that recovery will be quick and the habit will not take root.

Strict Diagnostic Criteria

People seeking help for symptoms of rumination syndrome typically must undergo a clinical evaluation from a licensed physician. To receive a diagnosis, they need to meet three criteria:

repeated regurgitation that begins soon after eating and does not occur during sleep or respond to GERD treatment,

no retching, and

symptoms that don’t occur as a result of other diseases like inflammatory conditions, metabolic changes, or tumors. These criteria must be met for at least three months.

Treatment: Behavioral Therapy

Most individuals with rumination syndrome respond well to behavioral therapies. Treatment can include habit reversal and relaxation strategies, as well as advanced techniques, such as biofeedback. Several practitioners can provide therapy, including psychologists, nurses, and gastroenterologists. In some cases, patients who don’t respond to these therapies require prescription medication.

Growing Awareness

Although data on rumination syndrome is limited, it was once thought to be incredibly rare. However, with advances in medicine and diagnostic technology, physicians are finding it simpler to rule out other conditions, and diagnoses have become more common. Greater awareness of this condition among physicians may have also contributed to this increase in diagnoses.