Rumination Syndrome: Causes, Symptoms, Diagnosis, Treatment and Complications

Rumination syndrome is characterised by recurrent vomiting of partially or fully digested food from the stomach. The food that has been regurgitated is either swallowed or thrown out after being consumed again. Those who experience rumination syndrome don't try to remember their meals.

Because it hasn't been completely digested, the food appears to taste like regular food and isn't acidic like vomit. Rumination happens during and immediately after meals most of the time.

It is unknown how many people have this disease. Treatment options include behavioural therapy and medication. One common component of behavioural therapy is teaching patients to breathe from their diaphragm.

Causes Of Rumination Syndrome

The precise cause of rumination syndrome is unknown. Still, it appears to be caused by increased intraperitoneal pressure.

Many times, bulimia nervosa, gastroparesis, and gastroesophageal reflux disease (GERD) are confused with rumination syndrome. In some people, rumination syndrome is associated with a rectal evacuation issue. An issue with rectal evacuation, and faulty pelvic floor muscles are the cause of inconsistent constipation.

It has long been known that the syndrome can affect newborns and people who are experiencing developmental challenges. It is now clear that the condition does not discriminate based on age because it can affect children, teens, and adults. Rumination syndrome is more common in those with anxiety, depression, and other mental health conditions.

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Symptoms Of Rumination Syndrome

Rumination syndrome manifests as some of the following symptoms:

• Simple regurgitation that typically takes place a short while after eating.
• Pressure or pain in the abdomen is released by regurgitation.
• A feeling of fullness
• Feeling dizzy
• Losing weight naturally

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DiagnosisOf Rumination Syndrome

To diagnose rumination syndrome, a physician will ask about current symptoms and acquire a medical history. Rumination syndrome is often diagnosed based on this preliminary assessment and behavioural observation.

Studies including high-resolution oesophagal manometry and impedance testing are occasionally utilised to support the diagnosis. This test ascertains whether there is an increase in abdominal pressure. It can also show a picture of the unconventional role that behavioural therapy may employ.

Additional testing that could be done to rule out other possible causes of your child's symptoms include:

• Upper endoscopy: This test offers close-up images of the stomach, the upper part of the small intestine, and the oesophagus to rule out any obstruction. A biopsy or small tissue sample may be obtained for additional investigation.
• Gastric Emptying: This method can be used to estimate the transit time of food through the stomach. Another version of this test can be used to determine how long food takes to move through the colon and small intestine.

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Treatment Of Rumination Syndrome

After all other illnesses have been ruled out, rumination syndrome is treated according to age and cognitive ability.

Modification of behaviour

Patients with rumination syndrome who do not have developmental issues are treated with behaviour therapy based on habit reversal. The first thing you need to learn is how to spot rumination moments. 

When rumination takes hold, you use your abdominal muscles to breathe in and out. This technique is known as diaphragmatic breathing. Diaphragmatic breathing prevents the stomach from contracting and regurgitating.

Biofeedback is a component of behaviour therapy for rumination syndrome. To stop regurgitation during biofeedback, you or your child might learn diaphragmatic breathing strategies with the help of imaging.

The major objective of neonatal therapy is usually to work with parents or other carers to change the infant's environment and conduct.

Medications

Medication that calms the stomach may help some people with rumination syndrome after they eat.

If frequent rumination is harming the oesophagus, proton pump inhibitors such as omeprazole or esomeprazole may be advised. These drugs can protect the stomach lining until lifestyle changes reduce reflux frequency and severity.

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Complications Of Rumination Syndrome

Possible consequences of rumination syndrome include the following:

• Unhealthy reduction in weight
• Starvation
• Teeth with dents
• Bad breath
• A sense of guilt
• Social isolation

The tube that joins the mouth and stomach, the oesophagus, may suffer damage if rumination syndrome is not treated.

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