Rumination Syndrome

Rumination syndrome is a condition where people constantly regurgitate and either vomit or re-swallow their food or drink soon after eating.

What is Rumination Syndrome? 

Rumination syndrome 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 occurs in children and adolescents with intact cognitive abilities.

What Are the Symptoms of Rumination Syndrome?

While the symptoms listed above are common to patients with rumination syndrome, 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.

Rumination syndrome 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, psychological stressors, or the way in which the brain and the GI system are interacting with one another.

Medical histories of patients with rumination syndrome 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 pressure on the stomach and the food or fluid coming back up.

If you would like more information about the Rumination Syndrome Program at Nationwide Children's Hospital, please fill out this online form and someone will respond within 48 hours.

How is Rumination Syndrome Diagnosed? 

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 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

How is Rumination Syndrome Treated? 

Several studies of the treatment of rumination syndrome have produced some very positive and exciting findings. Since rumination syndrome is quite complex, it makes sense that research has highlighted many important parts in the treatment of rumination syndrome.

  1. Education. Families who understand the diagnosis, do not worry that perhaps another condition is present, and who take an active part in treatment tend to make the most progress in treatment.
  2. Treating the trigger symptoms. Treating symptoms such as nausea or bloating that occur after eating can reduce the frequency of the rumination behavior.
  3. Undoing the newly learned "habit." Treatment includes focusing on increasing awareness of what your abdominal muscles are doing, learning new behaviors for the abdominal muscles instead of tightening, and keeping the body relaxed during mealtimes.
  4. Retraining the stomach to hold food again. Patients benefit from starting very slowly with small amounts and then gradually increasing their stomach's ability to tolerate greater amounts of food and fluid.
  5. Teaching self-regulation. Learning how to regulate the autonomic nervous system allows for greater physical relaxation as well as management of the trigger symptoms.
  6. Identifying and addressing other problems. Many patients with rumination syndrome also experience depression, anxiety, worry, and stress. Often, these problems arise from having rumination syndrome. These conditions make rumination syndrome worse, and tend to make it more difficult to treat. For this reason, it is important to note when these problems are present, and work on them as part of treatment.

The Rumination Syndrome Program at Nationwide Children's was developed based on the components of treatment listed above, and designed specifically to help patients suffering from rumination syndrome. Our program has short-term and long-term goals.

Short-term goals

  • To educate patients and families about rumination syndrome
  • To evaluate and treat the whole patient, including their rumination, overall GI functioning, nutritional needs, psychological functioning, coping, and physical conditioning.
  • To instruct patients in multiple self-management strategies
  • To have patients use these strategies to keep down enough food and fluid to maintain weight and no longer require tube feedings or IV's.
  • To kick off patients' journey toward resolution of their rumination.

Long-term goals

  • To have our patients feel confident and prepared to continue their treatment at home in a real-world setting
  • To have rumination have much less of an impact on the patient's daily functioning and quality of life.

Impact on Quality of Life

While rumination syndrome 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 (35% of the patients we have seen have switched to home schooling or home-bound instruction due to their problems with rumination syndrome)
  • No longer participating in sports or athletic activities, resulting in physical deconditioning
  • Emotional struggles with anxiety, depression and stress.