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Rumination Syndrome: Signs, Symptoms and Treatment

Sep 10, 2019
image of teen boy eating a bowl of cereal

What Is Rumination Syndrome?

Rumination syndrome, a functional gastrointestinal disorder (FGID), is a rare condition in which food and drink that has been swallowed but not yet digested is involuntarily regurgitated, or brought back up, shortly after intake. The process of regurgitation is described as effortless, meaning that what comes up is not forceful and does not include retching or gagging. Those with rumination syndrome swallow the food again or spit it out. Although rumination was previously thought to occur mostly in infants and young children, we now understand that rumination can impact individuals of any age.

What Causes Rumination Syndrome?

Symptoms of rumination syndrome usually begin with a triggering event, such as a stressful change in a child’s life, an infection or viral illness, like a cold. These triggers can cause the child to develop sensitivity in the nerves of their digestive tract. As a result, when food or liquid enters the stomach, the GI tract nerves are activated, causing abdominal wall muscles to contract. The contraction of the abdominal muscles causes the stomach to squeeze, sending the food or fluid back up. Even after the infection or stress has gone away, the regurgitation continues, similar to a habit.

What Are the Symptoms?

In addition to the effortless regurgitation of food or fluids after intake, other symptoms associated with rumination syndrome can include:

  • Dehydration
  • Weight loss
  • Bad breath
  • Nausea
  • Fatigue or decreased energy
  • Decreased quality of life

Some school-aged children with rumination syndrome end up missing school and stop participating in sports and other activities because they are embarrassed or are experiencing anxiety as a result of their condition. Sometimes, the weight loss and dehydration are severe enough to require enteral feeding, which is the administration of food and drink through a tube to maintain nutrition and hydration.

How Is Rumination Syndrome Diagnosed?

Diagnosing rumination syndrome does not require any formal testing. A medical professional reviews a patient’s medical history and previous tests to ensure there is no other diagnosis that could better explain the symptoms. They may suggest additional testing to rule out other conditions. Often, the patient’s medical history and the symptoms they are experiencing are enough to make a diagnosis of rumination syndrome. Sometimes, patients will be asked to eat or drink something for the medical professional to observe the symptoms after intake to confirm the diagnosis.  

How Is Rumination Syndrome Treated?

Treatment of rumination is often multidisciplinary, including gastroenterologists, pediatric psychologists, dieticians and other services as needed. Treatment starts with accepting and understanding the diagnosis of rumination. In order for treatment to be successful, patients must be motivated to work toward addressing their symptoms.

Some medications can be useful in managing associated symptoms of rumination; however, there is no medication that stops rumination from occurring. Instead, treatment is largely done with a psychologist to engage in “gut-directed therapy” to help retrain the stomach to accept food and drink rather than reject it. This therapy includes a combination of strategies, including reswallowing regurgitation, changing eating habits, and engaging in breathing using the diaphragm to manage abdominal muscle contractions. Treatment often includes eating with the psychologist to work on these strategies as rumination symptoms are occurring.

Treatment of rumination does not necessarily cure a patient of the symptoms. Most patients say they learn skills to manage their symptoms so they are less bothersome and interfere less with daily functioning. Some patients do stop having regurgitation altogether, but some continue to have some symptoms at times. Symptoms can sometimes return after a period of time, often triggered by an illness such as a gastrointestinal virus. In such circumstances, patients are usually able to regain control of their symptoms by using strategies they previously learned from treatment.

Learn more about rumination syndrome and the treatment program at Nationwide Children’s Hospital.
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Nationwide Children's Hospital Medical Professional
Ashley Kroon Van Diest
Psychology

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