Rumination syndrome

Rumination syndrome (also known as rumination or merycism) is a condition in which someone repeatedly regurgitates food shortly after eating, bringing up partially digested food into the mouth, then either re-chewing and re-swallowing it or spitting it out. Rumination typically happens at every meal, soon after eating. This condition is often associated with certain behaviours such as sucking, swallowing air, or tightening the abdominal muscles.

It has been reported 1 in 125 people in the general population experience rumination syndrome, but the actual number is likely to be underestimated as it is an under recognised condition.

The exact cause of rumination syndrome is not fully understood, but it's believed to involve a dysfunction in the normal coordination of the muscles involved in swallowing and digestion.

One suggestion is that food expands in the stomach increasing abdominal pressure and a relaxation of the LOS resulting in regurgitation.

Symptoms of rumination syndrome include:

• Effortless regurgitation, typically within minutes of eating.

• Belly pain or pressure relieved by regurgitation.

• A feeling of fullness.

• Nausea.

• Losing weight without trying.

Diagnosis

For rumination to be diagnosed all of the following must be fulfilled for the last 3 months, with symptom onset at least 6 months prior to diagnosis:

• Persistent or recurrent regurgitation of recently ingested food into the mouth with subsequent spitting or re-mastication and swallowing.

• Regurgitation is not preceded by retching.

• No evidence of an inflammatory (inflammation), anatomic (structural abnormality), metabolic, or neoplastic (cancer) process that explains the subject’s symptoms.

Treatment

Breathing exercises / behavioural therapy

Rumination Syndrome is considered a behavioural disorder. Diaphragmatic breathing is thought to break the habit and retrain the muscles to compete with the urge to ruminate. If practiced correctly, it is not possible to tense the abdominal muscles to increase the gastric pressure during this breathing exercise, and therefore during the exercises it is not physically possible to ruminate.

Medication

PPIs may be prescribed but don't stop the process, just help any oesophagitis symptoms it may cause.

Baclofen has been shown reduce LOS relaxations. It can have side effects, however, and is usually only prescribed when breathing exercises don't work.

Surgery

Although Laparoscopic Nissen Fundoplication has been tried, it hasn't been shown to be effective for this condition.

Acknowledgement

Much of this information was informed by Guts UK charity, patient information page on Rumination Syndrome.

Page updated 6 February 2024