The rumination syndrome: Clinical features rather than manometric diagnosis

doi:10.1016/0016-5085(95)90199-X

Gastroenterology

Volume 108, Issue 4, April 1995, Pages 1024-1029

https://doi.org/10.1016/0016-5085(95)90199-X Get rights and content

Abstract

$Background/Aims:$ Rumination is infrequent in adults of normal mental capacity. Upper gastrointestinal manometry reportedly confirms the diagnosis. Clinical characteristics, treatment(s), and outcomes of these patients are unclear. $Methods:$ We assessed 38 adults and adolescents with rumination between 1987 and 1994. Esophagogastroduodenal manometric recordings (n = 36; 3-hour fasting and 2-hour postprandially) were reviewed; follow-up information was obtained from mailed questionnaires. $Results:$ Patients saw a mean of five physicians and had symptoms for a mean of 2.75 years before diagnosis. Features included daily, effortless regurgitation of undigested food starting within minutes of meals. Weight loss was substantial (mean, 29 lb) in 42% of patients. Seventeen percent of female patients had a history of bulimia. Manometry confirmed the clinical diagnosis in 33% but was otherwise normal in all. Of 16 patients who responded to our questionnaires of 29 with >6 months of follow-up (average, 35 months), 12 reported subjective improvement. In 14, the behavior persists. $Conclusions:$ The rumination syndrome is underdiagnosed. With typical clinical features, gastroduodenal manometry seems unnecessary to confirm the diagnosis. Diagnosis and reassurance are important in management to avoid unnecessary tests and treatments.

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Cited by (127)

Rumination syndrome
2023, Handbook of Gastrointestinal Motility and Disorders of Gut-Brain Interactions, Second Edition
Rumination syndrome is a distinct functional gastrointestinal disorder that is characterized by repetitious, effortless regurgitation that occurs during or shortly after eating, followed by spitting out the regurgitant or re-mastication and re-swallowing. It is an unconscious reflex response that is associated with gastric visceral hypersensitivity, and generally preceded or accompanied by belching, burping, and epigastric abdominal wall pain. The syndrome was first documented in 1618 by an Italian anatomist, Fabricius ab Aquapendente, who described the symptoms in one of his patients. The search for better recognition and understanding of the condition has ensued over the subsequent decades.
Cognitive-Behavioral Intervention for Pediatric Rumination Disorder: A Single Case Experimental Design
2023, Cognitive and Behavioral Practice
This report presents the single case of Liam, a 10-year-old boy with rumination disorder (RD) and subclinical symptoms of anxiety. The primary aim was to explore the effectiveness of habit reversal therapy (HRT) in reducing regurgitation frequency in a young child. The secondary aim was to explore whether modular cognitive-behavioral techniques, based on idiosyncratic cognitive-behavioral formulations tailored to the child, may further augment the effect of habit reversal therapy on regurgitation frequency. An A-B-C design was utilized to compare regurgitation frequency and emotional distress across baseline, intervention (primary and secondary), and follow-up phases. Results demonstrated that HRT adapted for children was an effective approach to reducing regurgitation frequency. Self-monitoring alone and additional anxiety management skills provided further benefits to regurgitation frequency though to a lesser extent. Research on pediatric RD remains scarce, particularly regarding treatment for children of a younger age with additional psychological difficulties within clinical settings. Results from the current case study suggest that HRT adapted for children with RD and additional internalizing symptoms in a real-life clinical setting was feasible, acceptable, and effective. More research needs to be conducted on standardizing age-appropriate treatment adaptations for young children with RD and on exploring whether and which cognitive-behavioral techniques provide further meaningful reductions in regurgitation frequency.
Rumination Syndrome “Real Prevalence”: A Need to Increase Awareness, Early Recognition, and Specific Management
2022, Gastroenterology
Rumination syndrome: Critical review
2022, Gastroenterologia y Hepatologia
El síndrome de rumiación es un trastorno funcional caracterizado por la regurgitación involuntaria de los alimentos recientemente ingeridos desde el estómago hacia la boca, donde puede ser remasticados o expulsados. Desde el punto de vista clínico, se caracteriza por episodios repetidos de regurgitación de alimentos sin esfuerzo, con vómitos frecuentes como queja habitual. El mecanismo físico que genera los eventos de regurgitación depende de un proceso involuntario que altera las presiones abdominal y torácica, acompañado de una unión esofagogástrica permisiva. El diagnóstico del síndrome de rumiación es clínico: destaca la importancia de realizar una anamnesis exhaustiva sobre las características de los síntomas. Las pruebas complementarias se utilizan para corroborar el diagnóstico o descartar otra enfermedad orgánica. El tratamiento está enfocado a terapias conductuales como primera línea, reservando las terapias farmacológicas y quirúrgicas para casos refractarios.
Rumination syndrome is a functional disorder characterized by the involuntary regurgitation of recently swallowed food from the stomach into the mouth, from where it can be re-chewed or expelled. Clinically, it is characterized by repeated episodes of effortless food regurgitation. The most usual complaint is frequent vomiting. The physical mechanism that generates regurgitation events is dependent on an involuntary process that alters abdominal and thoracic pressures accompanied by a permissive oesophageal-gastric junction. The diagnosis of rumination syndrome is clinical, highlighting the importance of performing an exhaustive anamnesis on the characteristics of the symptoms. Complementary tests are used to corroborate the diagnosis or rule out organic pathology. Treatment is focused on behavioural therapies as the first line, reserving pharmacological and surgical therapies for refractory cases.
Rumination syndrome. A review article
2021, Revista de Gastroenterologia de Mexico
El síndrome de rumiación es un trastorno funcional gastrointestinal que se caracteriza por la regurgitación posprandial sin esfuerzo de los alimentos ingeridos hasta la boca, en el que la contracción posprandial no percibida de la pared abdominal sería un mecanismo clave. En estos pacientes, el flujo retrógrado del contenido gástrico ingerido hasta la boca se produce debido a la combinación de una presión intraabdominal elevada con una presión intratorácica negativa. La prevalencia estimada es de alrededor del 2% en la población general adulta. Las características clínicas principales incluyen: a) regurgitación posprandial precoz; b) el material regurgitado sin esfuerzo es similar al alimento ingerido; c) el material regurgitado se escupe o se vuelve a tragar. El diagnóstico clínico del síndrome de rumiación requiere el cumplimiento de los criterios clínicos. Las pruebas de manometría esofágica de alta resolución idealmente con impedancia pueden representar un complemento importante para el diagnóstico clínico. Su manejo se basa en la instrucción acerca de la naturaleza del trastorno, la educación en respiración diafragmática posprandial y la evaluación de posible comorbilidad psiquiátrica. El uso del baclofeno se reserva como segunda línea para pacientes con síntomas refractarios.
Rumination syndrome is a functional gastrointestinal disorder characterized by effortless postprandial regurgitation of ingested food into the mouth. An unperceived postprandial contraction of the abdominal wall could be a key mechanism. In those patients, retrograde flow of the ingested gastric content into the mouth is produced due to a simultaneous combination of elevated intra-abdominal pressure and negative intrathoracic pressure. The estimated prevalence is around 2% in the general adult population. The main clinical characteristics include: a) early postprandial regurgitation, b) the effortlessly regurgitated material is similar to the ingested food, c) the regurgitated material is spit out or swallowed again. The clinical diagnosis of rumination syndrome relies on the clinical criteria. High resolution esophageal manometry, ideally including impedance monitoring, can be an important adjunct for making the clinical diagnosis. Its management is based on instruction as to the nature of the pathology, education in postprandial diaphragmatic breathing, and the assessment of possible psychiatric comorbidity. Baclofen use is reserved for second-line treatment in patients with refractory symptoms.
Rumination syndrome and gastroparesis: Linked entities?
2021, Revista de Gastroenterologia de Mexico

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Alimentary tractThe rumination syndrome: Clinical features rather than manometric diagnosis

Abstract

J Behav Ther Exp Psychiatry

J Am Acad Child Psychiatry

Am J Clin Nutr

Res Dev Disabil

Gastroenterology

Gastroenterology

Gastroenterology

Sensory nervous receptors in the ruminant stomach and reflex control of reticula-ruminal motility

Voluntary induction of transient lower esophageal sphincter relaxation in an adult patient with the rumination syndrome

Am J Gastroenterol

The rumination syndrome in adults

Ann Intern Med

The rumination syndrome in an adult patient

J Clin Gastroenterol

Manometric study of a ruminator

J Clin Gastroenterol

Alimentary tract
The rumination syndrome: Clinical features rather than manometric diagnosis