Rumination Syndrome: Symptoms, Causes, and Diagnosis
Rumination syndrome is an unusual condition where people regurgitate undigested or partially digested food from the stomach. The food is then chewed again and swallowed or spit out. Rumination occurs in some people and is believed to be a behavioural condition.
The term “rumination” means to chew over regurgitated food. It’s common in animals but is unnecessary (and potentially dangerous) in humans. Unlike other conditions, regurgitation doesn’t occur because of a physical problem. The regurgitation happens effortless as part of eating.
What is Rumination Syndrome?
Rumination Syndrome is a rare digestive condition where recently swallowed food is effortlessly regurgitated, re-chewed, and either spat out or swallowed again. Unlike vomiting, this regurgitation is not forceful or accompanied by nausea or retching.
It usually happens within minutes of eating and is often mistaken for acid reflux or an eating disorder. The condition is caused by an involuntary contraction of the abdominal muscles, leading to pressure in the stomach that pushes food back up.
While it can affect people of all ages, it’s more common in children and adolescents. It’s estimated that around 1 in 125 people experience rumination syndrome. However, that figure is likely an underestimate as it is widely underdiagnosed.
Rumination Syndrome Symptoms
Despite being rare, rumination syndrome is relatively simple to diagnose. It follows a characteristic pattern in most patients.
Typical symptoms include:
Effortless regurgitation of recently eaten food
Regurgitation within minutes of eating
No nausea or retching
Re-chewing or re-swallowing food
Bad breath
Bloating or abdominal discomfort
Unintentional weight loss (in severe cases)
Causes of Rumination Syndrome
The underlying cause behind rumination is not clear. It’s linked to an increase in abdominal pressure that causes food to be pushed backwards into the esophagus, throat, and mouth because of abdominal contractions.
The condition is not associated with any heartburn symptoms but there might be some mild acid reflux. However, because the food is yet to be digested, there usually isn’t sufficient acid in the stomach to cause irritation.
Rumination syndrome is increasingly linked to anxiety, depression, and other psychiatric disorders. Some people also suggest that it’s a behavioural condition related to bulimia nervosa. But this is yet to be confirmed.
Diagnosing Rumination Syndrome
If you’ve experienced regurgitation, bloating, or unintentional weight loss, it’s crucial to see your doctor. They’ll ask you questions about your current symptoms and medical history. An examination may then be performed if necessary.
Regurgitation is a common symptom in other conditions, e.g., achalasia, GERD, and Zenker’s diverticulum. Your doctor may request several tests to rule out these conditions first:
High-Resolution Esophageal Manometry. This test evaluates how well the muscles of the oesophagus and lower esophageal sphincter (LES), which acts as a valve to the stomach, function. If there is a problem with the opening or closing of the LOS, or the way in which the muscles contract, it can support a diagnosis of achalasia, esophageal spasm, and other conditions.
Upper Endoscopy. A thin, flexible tube with a camera is threaded down your throat to look for any abnormalities or blockages. Biopsies can also be taken if necessary to provide a concrete diagnosis.
Gastric Emptying. This procedure measures how long it takes for food to pass through the stomach. If this is slower than normal, it might be responsible for your regurgitation.
Rumination is often hard to diagnose and hence the use of the above tests to rule out other causes of the symptoms. Once everything else is ruled out, it becomes the most likely candidate. Often the high-resolution esophageal manometry test can provide useful information to help identify rumination as muscle contractions of the stomach can be identified.
During the manometry, rumination protocol can be followed which involves consuming a small meal, often a bowl of cereal or porridge, and then waiting for approximately 10-minutes. During this time, the action of the stomach muscles are monitored and recorded to see if any abnormal contractions occur.
Treatment Options for Rumination Syndrome
Treating rumination syndrome primarily involves training the body to stop regurgitating food. A type of behavioural therapy called diaphragmatic breathing is a popular approach. Medication may also be recommended in certain individuals.
Behavioural Therapy
The specific type of behavioural therapy for rumination syndrome is called diaphragmatic breathing. The diaphragm is a dome-shaped muscle separating your abdomen and chest. It helps you breathe. The aim of diaphragmatic breathing is to strengthen the diaphragm and retrain the muscles to relax rather than contract after meals.
The exercise involves:
Lie on your back with knees bent and head supported or sit up straight in a comfortable chair. You can place a pillow under your knees or behind your back for comfort.
Place one hand on your chest and the other on your belly, just below the ribcage.
Inhale slowly through your nose. Let your belly rise and push out while keeping your chest still.
Exhale through pursed lips, tightening your stomach muscles so your belly falls inward.
Continue slowly for 5 to 10-minutes after a meal, keeping the hand on your chest still.
Medicine
At the moment there is unfortunately no medications available to specifically target and treat rumination syndrome. However, if rumination occurs to the point that the oesophagus is becoming damaged, taking a proton pump inhibitor (PPI), like esomeprazole (Nexium) or omeprazole (Prilosec) can reduce acid production. This will relieve any heartburn symptoms and prevent long-term complications.
Ready to Find Relief from Heartburn Symptoms?
If you’re experiencing repeated bouts of heartburn, it’s important to act fast. Acid exposure can permanently damage your oesophagus – even in the small quantities that occur in rumination syndrome.
Find out more about heartburn symptoms, potential causes, and our diagnostic testing options. We can help you feel more comfortable and confident each time you eat.
