Rumination Syndrome is a condition that occurs when people constantly regurgitate and either vomit or re-swallow their food or drink soon after eating. Although the syndrome was first described many years ago as occurring in young children with developmental disabilities, it is now recognized that the syndrome often occurs in children and adolescents with intact cognitive skills.
Even though more professionals are aware of rumination syndrome today, this condition still remains infrequent, poorly understood, and often misdiagnosed. Rumination syndrome frequently is confused with other gastrointestinal problems (for example, gastroparesis or gastroesophageal reflux disease) or eating disorders.
The diagnosis of rumination disorder does not require any diagnostic testing. There are specific diagnostic criteria that exist that help professionals make the diagnosis. The symptoms of rumination syndrome are:
Rome III Criteria for Adolescent Rumination Syndrome
While these symptoms are common to patients with rumination syndrome, each patient with rumination syndrome has a different presentation. In other words, the symptoms can look quite different person to person. While some patients vomit immediately after eating even one bite of food, others are able to eat a good deal of food before the rumination starts. Some patients feel pain with eating. Others feel nausea. Some patients do not have any sensations before the rumination begins.
Although we do not know exactly how rumination syndrome starts, medical histories of patients with the syndrome suggests that the symptoms often begin with some “triggering” event. This can be a viral infection, a GI disease, or even stress happening in the patient’s life. After this infection, event, or stressor has gone away, the vomiting behavior remains in place, almost similar to a “tic.” As a consequence, when food or liquid enters the stomach, the body has learned a new behavior – contraction of the abdominal muscles – that results in the food or fluid coming back up.
What do we mean by “stress”? Stress can be defined in many ways. Stress can be physical, emotional or mental. Most people describe the feeling of stress as “strain” or “tension.” There are several different types of stress that all people experience.
Several studies of the treatment of rumination syndrome have produced some very positive and exciting findings. There seem to be many important components to the treatment of this condition.
While some patients with rumination syndrome can be treated in the outpatient setting closer to their homes, other patients benefit from an admission to the hospital. An inpatient admission is essential for patients who are reliant on tube feedings or parenteral nutrition, as their nutrition and hydration need to be closely monitored.
Our program is unique, in that we have multiple experts working with our patients, all with different backgrounds and skills, but all working toward the same goal of eliminating the rumination behavior. Our team consists of members of each of the following disciplines: Gastroenterology, Pediatric Psychology, Clinical Nutrition, Child Life, Massage Therapy, and Therapeutic Recreation. The daily schedule includes times with each therapist, and specific times each day in which patients work on their eating skills.
We have found that patients age 12 and older seem to do the best in our program. Our treatment approach requires patients to have insight into their challenges, be able to work independently, and to have the ability to work continuously throughout the day.
I am 17 years old and I was diagnosed with a motility disorder called Rumination Syndrome. For almost 3 years I threw up almost everything that I ate or drank. I lost 25% of my body weight and was placed on an NJ feeding tube to help me maintain my weight and nutrition. My doctors considered putting me on a permanent feeding tube because they did not know of any other methods of treatment to help me.[read more...]
I was tested extensively, but none of the many professionals I saw were able to provide me with any answers or treatments that could stop me from throwing up. I was, however, advised that there was no physical cause for my condition. I eventually became too weak to go to school or participate in normal activities. After almost 3 years I was fortunate enough to be referred and admitted to Nationwide Children’s Hospital in Columbus, Ohio. I stayed at Nationwide Children’s for one week, in which time they were able to retrain my stomach to accept food and liquids. By the time I was discharged from Nationwide Children’s I was able to eat and drink normally again. After only a few months of being discharged I found myself able to eat complete meals without throwing up.
My whole life has changed thanks to the expertise and compassionate care that I received from the doctors at Nationwide Children’s. I’ve gained weight and I feel much stronger. I’ve been able to resume a normal life and it’s been years since I was so happy and carefree. If you or anyone you know has Rumination Syndrome I would strongly recommend that you seek help at Nationwide Children’s.