About Adolescent Rumination Sydrome :: Nationwide Children's Hospital

What is Adolescent Rumination Syndrome?

Adolescent Rumination Syndrome (ARS) is a condition where 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 abilities.

The diagnosis of rumination disorder does not require any formal diagnostic testing. There are specific diagnostic criteria that exist that help professionals make the diagnosis. The symptoms of Adolescent Rumination Syndrome are:

  1. At least a two-month history of repeated regurgitation and re-chewing or expulsion of food
  2. The behavior begins soon after ingestion of a meal
  3. The behavior does not occur during sleep
  4. There is no retching
  5. Symptoms do not respond to standard treatment for gastroesophageal reflux (GERD).
  6. No evidence of an inflammatory, anatomic, metabolic or neoplastic process considered likely to be an explanation for the patient’s symptoms

While the symptoms listed above are common to patients with ARS, each patient we see 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 report any sensations before the rumination begins.

ARS falls into a category of GI conditions called Functional Gastrointestinal Disorders.  As with any functional disorder, while no disease or physical abnormality is present, the patient is suffering from very real problems.  The problems result from the interaction of many factors including nerve sensitivity, a stress to the body (often caused by a viral infection), psychological stressors, or the way in which the brain and the GI system are interacting with one another.  

Medical histories of patients with ARS suggest 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 stress has gone away, the vomiting behavior remains in place, almost similar to a “habit.” 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.

Impact on Quality of Life

While ARS itself is not life-threatening, the problems that develop around the rumination are quite debilitating.  Some of these problems include:

  • Heightened GI sensitivity resulting in severe abdominal pain, nausea, bloating, and/or pressure that makes having food or fluid in the stomach intolerable
  • Greater risk for dehydration, malnutrition, and weight loss
  • Poor school attendance (25% of the patients we have seen have switched to home schooling or home-bound instruction due to their problems with ARS)
  • No longer participating in sports or athletic activities, resulting in physical deconditioning
  • Emotional struggles with anxiety, depression, and stress.
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