Table 2

Differential diagnoses and important clues for rumination syndrome

Type of pathologyCluesDiagnosis
Physical pathology

  • Occurring after meals

  • Nausea free

  • Effortless

  • Regurgitant not acidic

  • Recognisable undigested food

Rumination syndrome

  • Positional

  • Ameliorated by PPIs

  • Acidic regurgitant

GORD

  • Nausea

  • Pain

Achalasia

  • Nausea

  • Diabetes(Often with other complications, neuropathy, etc)

Gastroparesis

  • Nausea

  • Borborygmi

  • Succussion splash

Gastric outlet obstruction
Mental illness

  • Nausea

  • Self-induced

  • Body image-related symptoms

Bulimia nervosa

  • GORD, gastro-oesophageal reflux disease; PPI, proton pump inhibitors.