Rumination syndrome, or rumination disorder, causes you to regurgitate food back up through your mouth after you swallow it. Experts do not know what exactly causes rumination syndrome, but some evidence suggests that it’s an unconscious behavior.
Some infants and children develop the disorder due to developmental delays or neglect during infancy. Adults might regurgitate after physical injuries or viral illnesses. Behavioral therapies help treat rumination syndrome. For example, breathing exercises and distracting yourself after eating help prevent regurgitation.
Rumination syndrome affects about 2.8% of people globally, most commonly including infants and children. Read on to learn about rumination syndrome, including symptoms, causes, treatment, and more.
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According to the Diagnostic And Statistical Manual Of Mental Disorders, Fifth Edition (DSM-5-TR), you must meet this criteria to have rumination syndrome:
You have at least one month of repeated regurgitation of food.
Another health condition does not cause repeated regurgitation.
Anorexia nervosa, bulimia nervosa, binge-eating disorder, or avoidant/restrictive food intake disorder (AFRID) do not cause repeated regurgitation.
Regurgitation is severe enough to warrant separate attention.
People with rumination syndrome regurgitate their food, voluntarily or involuntarily, usually within 10–15 minutes of finishing a meal. You may regurgitate, re-chew, then re-swallow your food multiple times. Those repeated regurgitations might last for up to two hours.
The regurgitation that happens with rumination disorder is different than vomiting, Andrea Vazzana, PhD, a child and adolescent psychologist at NYU Langone Health, told Health. Regurgitation is the ejection of the contents of the esophagus before they get to the stomach.
In contrast, vomiting is a forceful ejection of food that your stomach has already broken down. Regurgitated food might resemble food that’s recently been chewed, but vomited food does not, said Vazzana.
Symptoms in Infants and Children
The ROME IV, which details criteria for functional gastrointestinal (GI) disorders, says infants typically show signs of rumination syndrome around 3–8 months old. Infants and children with the disorder will not have any other health condition that causes regurgitation or an eating disorder. GERD and regurgitation treatments will usually not alleviate their symptoms.
According to the ROME IV, infants and children must meet these criteria for at least two months to have rumination syndrome:
Absence of regurgitation while sleeping or interacting with othersDo not retch before regurgitatingDo not show signs of distress (in infants)Repeatedly contract their abdominal muscles, diaphragm, and tongue (in infants)Repeatedly regurgitate after swallowing food
The regurgitation that happens with rumination syndrome is a learned behavior. Not a lot is known about what causes people to regurgitate. One theory is that children who are neglected or under-stimulated might use regurgitation to soothe themselves, said Vazzana.
Physical injuries that alter sensations in your abdomen cause rumination syndrome in some people. For example, you might have discomfort if the bottom of your esophagus relaxes. Regurgitating your food can relieve that pressure. You may unconsciously adopt that behavior after some time.
Risk Factors
Anyone can develop rumination syndrome, but some are likelier than others. Risk factors include:
Developmental delay
Eating disorders
Fibromyalgia, which causes long-lasting pain, fatigue, and trouble sleeping
Neglect and a lack of stimulation during infancy
Other mental health conditions (e.g., anxiety, depression, and obsessive-compulsive disorder)
Physical injuries
Rectal evacuation disorder, or chronic constipation
Stressful family situations
Viral illnesses
Healthcare providers can typically diagnose rumination syndrome without invasive tests. They will likely ask about your health history and symptoms. It’s essential to discern if you are regurgitating undigested food or vomiting, which sets rumination syndrome apart from other illnesses.
People often confuse the rumination syndrome with gastroesophageal reflux disease (GERD) or illnesses that cause vomiting. As a result, it might take up to six years to receive a rumination syndrome diagnosis. A healthcare provider might refer you to a psychologist or psychiatrist for evaluation.
Other diagnostic tests might include:
CT enterography: This imaging test makes sure that you do not have a bowel obstruction, which blocks your small or large intestine.Electromyography (EMG): This measures muscle activity in your abdomen and chest. Regurgitation might cause increased activity in those areas.Endoscopy: A healthcare provider will insert a long instrument with a tiny camera, or endoscope, into your body to look for a bowel obstruction.Gastric emptying and pH studies: These tests check the movement of food through and the pH in your gut. pH is a measure of how acidic or basic something is. High-resolution esophageal manometry (HRIM): This test measures how food moves from the esophagus to the stomach after you swallow it. An HRIM helps confirm rumination syndrome in adults and children.
The goal of treatment is to undo the habit of regurgitation. You might work with a diverse team of healthcare providers, including a gastroenterologist, massage therapist, psychologist, and recreational therapist, to treat rumination syndrome.
Healthcare providers might advise behavioral treatments, such as:
Diaphragmatic breathing exercises: These teach you how to breathe from your diaphragm. You may place one hand on your chest and one on your lower abdomen. You’ll then breathe in such a way that only your lower hand moves when you inhale and exhale.
Distraction after mealtimes: You might try relaxation techniques to prevent regurgitation, Kasey Goodpaster, Ph.D., a psychologist at the Cleveland Clinic, told Health.
Self-monitor: You may record how often regurgitation happens and keep tabs on your emotions. Any feelings and thoughts that lead to regurgitation can help a psychologist figure out patterns that lead to it. That information helps them make recommendations on how to stop regurgitation.
A healthcare provider may prescribe baclofen, a pain medication, if behavioral treatments do not work. Baclofen is a skeletal muscle relaxant that helps treat muscle tightness and stiffness. There’s limited data on how well baclofen treats rumination syndrome. Still, some evidence suggests that the medication may help relieve symptoms.
There are no known ways to prevent rumination syndrome. Still, you might be able to reduce flares by practicing diaphragmatic breathing after you eat.
You may lower your infant or child’s risk by maintaining a healthy relationship with them. Neglect and a lack of stimulation during infancy are some of the most common risk factors for rumination syndrome that occurs in childhood. Make sure that you often stimulate and soothe your child.
Rumination syndrome may significantly impact your mental and physical health. People with the disorder might have notable weight loss if they keep regurgitating food. Some might mistake their weight loss for an eating disorder, which delays diagnosis and treatment.
Other complications may include:
Anxiety and depression: Some people often worry about regurgitation, which causes anxiety. You might avoid eating in front of other people. Feelings of distress and embarrassment might also increase your risk of depression.
Dental damage: Some evidence suggests that children with rumination syndrome are likelier to have tooth decay than others. Regurgitation might cause stomach acid to flow backward and into your mouth. As a result, stomach acid erodes enamel, the protective coating on your teeth.
Electrolyte imbalance: This happens if your body has too many or too few electrolytes, which include calcium, magnesium, potassium, and sodium. You might not consume enough of those minerals if you repeatedly regurgitate food.
Rumination syndrome is a behavioral disorder that causes you to regurgitate your food after swallowing it. It’s unclear what causes rumination syndrome, but some people might develop it due to neglect and a lack of stimulation during infancy. Adults might regurgitate after a physical injury or viral illness.
There’s no reliable way to prevent rumination syndrome. Still, you can work with a team of healthcare providers to unlearn regurgitation. Try diaphragmatic breathing and distracting yourself after eating. Taking steps to reduce rumination syndrome helps prevent mental and physical complications, such as anxiety, depression, electrolyte imbalance, significant weight loss, and tooth decay.
