Overview

Rumination disorder is a condition in which people repeatedly and unintentionally spit up (regurgitate) undigested or partially digested food from the stomach, rechew it, and then either reswallow it or spit it out.

Because the food hasn’t yet been digested, it reportedly tastes normal and isn’t acidic, as vomit is. Rumination typically happens at every meal, soon after eating.

The main symptom of this disorder is the repeated regurgitation of undigested food. Regurgitation typically occurs between a half hour to two hours after eating. People with this condition regurgitate every day and after almost every meal.

Symptoms

• bad breath
• weight loss
• stomach aches or indigestion
• tooth decay
• dry mouth or lips

Signs and symptoms of rumination disorder are the same in both children and adults. Adults are more likely to spit out regurgitated food. Children are more likely to rechew and reswallow the food.

When to see a doctor

Consult a doctor if you or your child persistently regurgitates food.

Causes

The precise cause of rumination syndrome isn’t clear. But it appears to be caused by an increase in abdominal pressure.

Rumination syndrome is frequently confused with bulimia nervosa, gastroesophageal reflux disease (GERD) and gastroparesis. Some people have rumination syndrome linked to a rectal evacuation disorder, in which poor coordination of pelvic floor muscles leads to chronic constipation.

The condition has long been known to occur in infants and people with developmental disabilities. It’s now clear that the condition isn’t related to age, as it can occur in children, teens and adults. Rumination syndrome is more likely to occur in people with anxiety, depression or other psychiatric disorders.

Risk factors

Rumination
disorder can affect anyone, but it’s most commonly seen in infants and children
with intellectual disabilities.

Some
sources suggest rumination disorder is more likely to affect females, but
additional studies are needed to confirm this.

Other
factors that may increase the risk of rumination disorder in both children and
adults include:

• having an acute illness
• having a mental illness
• experiencing a psychiatric disturbance
• undergoing major surgery
• undergoing a stressful experience

More
research is needed to identify how these factors contribute to rumination
disorder.

Diagnosis

Rumination syndrome can usually be diagnosed based on a
medical history and physical exam. In many cases, the patient’s
symptoms—specifically, the patient has been regurgitating, chewing and
swallowing food for at least 3 months, but is not vomiting the food—are enough
to make a diagnosis of rumination syndrome.

Officially, according to the Diagnostic and Statistical
Manual of Mental Disorders, Fifth Edition, a person must meet the following
criteria to be diagnosed with rumination syndrome:

• Repeated regurgitation of food over a period of at leat 1 month. Regurgitated food may be re-chewed, re-swallowed or spit up.
• Repeated regurgitation is not due to a gastrointestinal or other medical condition (for example, gastroesophageal reflux, pyloric stenosis)
• The eating disorder must not occur only in the presence ofanorexia nervosa, bulimia nervosa, binge eating disorder  or avoidant/restrictive food intake disorder.
• If the eating disorder occurs together with another mental disorder (for example, intellectual disability), symptoms must be severe enough and be the main reason for seeking medical care.

Doctors may use tests to rule out other medical issues, such as blockages. These tests may include:

• Gastric emptying test. Measures how long it takes for food to move from the stomach to the small intestine.
• Upper endoscopy. The doctor examines the esophagus and stomach through an endoscope (a thin tube with a camera on the end) inserted down the throat.
• X-rays. Provides doctors with images of the inside of the esophagus and stomach.

Complications

Untreated, rumination syndrome can damage the tube between your mouth and stomach (esophagus).

Rumination syndrome can also cause:

• Unhealthy weight loss
• Malnutrition
• Dental erosion
• Bad breath
• Embarrassment
• Social isolation

Treatment

Treatment for rumination disorder is the same in both children and adults. Treatment focuses on changing the learned behavior responsible for regurgitation. Different approaches may be used. Your doctor will tailor the approach based on your age and abilities.

The simplest and most effective treatment for rumination disorder in children and adults is diaphragmatic  breathing training. It involves learning how to breathe deeply and relax the diaphragm. Regurgitation cannot occur when the diaphragm is relaxed.

The diaphragm is a large, dome-shaped muscle located at the base of the lungs. Diaphragmatic breathing is intended to help you relax the diaphragm and use it correctly while breathing to strengthen it.

To perform diaphragmatic breathing to help control regurgitation:

1. Lie on your back on a flat surface or in bed, with your knees bent and your head supported. You can use a pillow under your knees to support your legs. Place one hand on your upper chest and the other just below your rib cage. This will allow you to feel your diaphragm move as you breathe.
2. Breathe in slowly through your nose so that your stomach moves out against your hand. Keep the hand on your chest as still as possible. For children, we describe this as “breathing like an opera singer”, with the hand on the belly moving out with each slow breath, and moving in with exhalation.
3. Tighten your stomach muscles, letting them fall inward as you exhale through pursed lips. Keep the hand on your upper chest as still as possible.

Practice this exercise for 5 to 10 minutes, three to four times a day. You can increase the effort of the exercise by placing a book on your abdomen. Individuals can also practice “belly breathing” after each bite or meal, as needed.

Apply diaphragmatic breathing techniques during and right after meals. Eventually, rumination disorder should disappear.

Other treatments for rumination disorder can include:

• changes in posture, both during and right after a meal
• removing distractions during meal times
• reducing stress and distractions during meal times
• psychotherapy

There is currently no medication available for rumination disorder.