Rumination Syndrome

What is rumination syndrome?

Rumination syndrome is a rare behavioral problem. It affects children and some adults. Rumination syndrome causes an automatic regurgitation of recently eaten food. Someone with this problem will often eat meals normally. But after about 10 to 15 minutes, undigested food comes back up into the mouth from the food pipe (esophagus). This may continue for about 1 to 2 hours. The person may rechew and reswallow the food. Or they may spit it out. Often this happens at every meal, day after day. Rumination is a reflex, not a conscious action.

Rumination syndrome is a rare problem. But it may be underdiagnosed because it is mistaken for another problem.

Rumination is most often diagnosed in children. But it's also diagnosed in adults.

What causes rumination syndrome?

Experts think rumination is unconscious. But they also believe that the voluntary muscle relaxation of the diaphragm becomes a learned habit. It's similar to the typical belching reflex. But rather than burping up gas, the reflex causes actual food to come back up.

What are the symptoms of rumination syndrome?

Rumination is different from throwing up. With rumination, the food is undigested. It often still tastes the same as when it was first eaten.

The symptoms of rumination syndrome may look like other health conditions or problems. Always talk with your healthcare provider for a diagnosis.

How is rumination syndrome diagnosed?

Throwing up is much more common. So rumination syndrome is often misdiagnosed as a vomiting disorder such as delayed digestion (gastroparesis) or heartburn (GERD or gastroesophageal reflex disease).

To diagnose rumination, healthcare providers need to ask the right questions. For instance, asking what the food tastes like when it comes up is important. If it still tastes good, this means the food was not digested. This means that rumination syndrome is a good possibility. Vomited food has been digested and often is not kept in the mouth.

The symptoms of rumination syndrome don't get better with normal treatment of reflux.

How is rumination syndrome treated?

Treatment will depend on your symptoms, age, and general health. It will also depend on how severe the condition is.

There currently aren’t any medicines available that effectively treat rumination syndrome. The best way to stop it is to relearn how to eat and digest food correctly. This requires diaphragmatic breathing training.

A behavioral psychologist often teaches this, and it's easy to learn. The method has to be used at the start of every meal to avoid regurgitation. Over time, most people can master the breathing method. This will stop the bad symptoms of rumination syndrome.

How can I help prevent rumination syndrome?

Experts aren't sure why rumination syndrome starts in the first place. So it's unclear what can be done to prevent it.

Living with rumination syndrome

The good news about rumination syndrome is that it doesn't seem to do much physical damage. In rare cases, it can cause problems with the esophagus from the acid and reflux. In some teens and adults, it has caused a small amount of weight loss.

Work with your healthcare provider or your child's healthcare provider to know the symptoms. Then work with a behavioral psychologist to end the pattern.

When should I call my healthcare provider?

Tell your healthcare provider if:

• Your symptoms get worse
• You have new symptoms

Key points about rumination syndrome

• Rumination syndrome is a rare behavioral disorder in which food is brought back up from the stomach. It's either rechewed, reswallowed, or spit out.
• The food will be described as tasting normally. This means it is still undigested. It's not acidic-tasting, like vomit.
• Rumination is a reflex, not a conscious action.
• This problem is a psychological disorder. It may be mistaken for vomiting or other digestive problems.
• Behavioral therapy will help you to notice the pattern and work to fix it.
• Rumination syndrome should be considered in anyone who vomits after eating, has regurgitation, and weight loss.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

• Know the reason for your visit and what you want to happen.
• Before your visit, write down questions you want answered.
• Bring someone with you to help you ask questions and remember what your healthcare provider tells you.
• At the visit, write down the name of a new diagnosis and any new medicines, treatments, or tests. Also write down any new instructions your healthcare provider gives you.
• Know why a new medicine or treatment is prescribed and how it will help you. Also know what the side effects are.
• Ask if your condition can be treated in other ways.
• Know why a test or procedure is recommended and what the results could mean.
• Know what to expect if you do not take the medicine or have the test or procedure.
• If you have a follow-up appointment, write down the date, time, and purpose for that visit.
• Know how you can contact your healthcare provider if you have questions, especially after office hours and on weekends and holidays.