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 regurgitate and either vomit or re-swallow their food or drink soon after eating. This can become more frequent or worsen over time and can occur in anyone at age.

What Are the Symptoms of Rumination Syndrome?

Rumination syndrome falls into a category of GI conditions called functional gastrointestinal disorders (FGID). As with any functional disorder, while no disease or physical abnormality is present, the patient is suffering from very real problems. The problem results from dysregulation in the way the brain and the GI system communicate. Other factors such as nerve sensitivity in the GI tract or psychological stressors can make rumination symptoms worse.

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.

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.

How is Rumination Syndrome Diagnosed? 

The diagnosis of rumination does not require any formal diagnostic testing. There are specific diagnostic criteria that help guide professionals in making the diagnosis. Upon review of the patient’s history and previous testing 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

Albert's Story: "I Have Rumination Syndrome"

Albert ended his sophomore year of high school with a mystery illness that left him unable to attend classes, play sports or hang out with friends because he was vomiting more than 30 times a day. It would take years of hospital visits, specialist appointments and extensive medical tests before Albert finally got answers.

Watch Albert's Story

How is Rumination Syndrome Treated? 

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. Click here to learn more about treatment in our program.

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.