Rumination disorder is a gastrointestinal disorder that causes a person to unintentionally regurgitate their undigested food shortly after ingestion.1 In most cases, the person expels or vomits up the food up to a half hour after eating. The patient could also regurgitate their food, rechew, then re-swallow it. It is important to note that regurgitation is an automatic reflex and not a controlled response to eating. The response typically occurs after every meal, every day.2
Table of Contents
Who Does Rumination Disorder Affect?
The disorder is typically a pediatric condition found in children as young as 3 months; however, adults may experience this condition as well. Females have been found to be affected by rumination disorder more commonly than males.2 A large percentage of those with rumination disorder also suffer from a mental disability. Nearly 10% of institutionalized patients suffering from a mental illness report also having rumination disorder.2 Those who have experienced an eating disorder such as bulimia or anorexia nervosa may have a predisposition towards developing this gastrointestinal disorder. Due to a lack of significant data, the exact percentage of people with rumination disorder is unknown, however, it is estimated to be extremely rare.1
Causes
There are no known direct causes of rumination disorder. However, many patients have reported that they experienced the disorder during stressful times.1 Neglect or a lack of stimulation may cause the onset of symptoms in infants. The presence of a pre-existing eating disorder, such as anorexia nervosa or bulimia, may also cause rumination disorder. It is very rare for the disorder to develop due to body image issues or as a result of an infection or illness.1
Symptoms
The main symptom of rumination disorder is the continuous regurgitation and rechewing of food for up to half an hour after ingestion. The behavior of regurgitating food may appear to be painless and the patient will appear to not experience any discomfort or disgust.2 Regurgitation may even cause pleasure for the patient. Up to 42% of patients have reported weight loss as a result of the condition.1 There are also other symptoms that patients experience such as heartburn, nausea, stomach pains, diarrhea, and/or constipation.1
Diagnosis
Diagnosing rumination disorder involves the observance of continuous regurgitation of food without the presence of another disease. The symptoms must also be present for at least one month in order for a doctor to make the diagnosis.2 Many other disorders are often misdiagnosed as rumination disorder. As a precaution, doctors must complete a thorough evaluation in order to rule out any other conditions before diagnosing a patient older than one year old with rumination disorder. Some tests involve performing barium swallows, upper endoscopies, abdominal X-rays, and other specialized tests.1 Most other conditions have a different pattern and timing of the regurgitation, which allows doctors to distinguish between disorders. Other conditions with the same symptoms as rumination disorder that are commonly confused include:1
- Gastroparesis (abnormal stomach emptying)
- Gastroesophageal reflux disease (GERD)
- An intestinal blockage
- Eating disorders like bulimia and anorexia nervosa
- Side effects of medication
Treatment
Most doctors choose to treat patients with rumination disorder by using behavioral modification. Habit reversal techniques are often used to aid in the extinction of the unwanted habit, regurgitation.1 Special breathing techniques are taught by behavior psychologists in 56% of cases to counteract the will to regurgitate.2 Medications and surgery have been found to be ineffective in treating rumination disorder. These solutions can even lead to further discomfort without treating the regurgitation. For infants with this disorder, the environment they are in is usually addressed. If there is neglect, then the child will usually be put in protective services. Nearly 85% of patients receiving treatment for rumination disorder report a full recovery.2 Seeking early treatment increases the chance of a full recovery. Patients with another disorder in addition to rumination disorder, such as an eating disorder, may require further therapy and treatment.
Complications
There are no reported chronic long-term effects of rumination disorder, but there are milder short-term effects including weight loss, malnutrition, vitamin deficiencies, and dental issues due to stomach acid.1 With proper, professional treatment, most of these side effects are reversible. Because the treatment of rumination disorder can be very extensive, children experiencing the disorder may miss school due to doctor’s appointments and/or hospitalization. Adults affected by this disorder may be forced to take a leave of absence from their jobs.
Concluding Remarks
Due to a lack of awareness about the condition, it is often misdiagnosed. Not treating the disorder can cause a person to miss out on many activities, like school, so an early diagnosis and treatment is imperative. If you notice you or your child repeatedly vomiting up or rechewing their food, call your doctor right away.
References
1. Mayo Clinic. Oct. 14, 2020. “Rumination syndrome – Symptoms and causes.” Mayo Clinic.
2. Updated By: Subodh K. Lal, MD, Gastroenterologist with Gastrointestinal Specialists of Georgia, Austell, GA. Review Provided by VeriMed Healthcare Network. Also Reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial Team. “Rumination Disorder: MedlinePlus Medical Encyclopedia.” Rumination Disorder: MedlinePlus Medical Encyclopedia. N.p., 27 Oct. 2015. Web. 03 Oct. 2016.
Last Updated: 10 October 2017.