Understanding Rumination Syndrome: Symptoms, Causes and Treatment Approaches
Understand comprehensive insights into Rumination Syndrome, including its symptoms, causes, diagnosis, and treatment options. Discover the ways to manage this rare digestive disorder effectively.
Written by Dr.Sonia Bhatt
Last updated on 3rd Jul, 2025
Rumination syndrome, also known as rumination disorder or merycism, is a rare and often misunderstood digestive disorder that is characterised by the repetitive and effortless regurgitation of recently ingested food. This regurgitation, unlike vomiting, is not preceded by discomfort or nausea, and the food typically retains its original taste. The regurgitated material can be re-swallowed, re-chewed, or spit out. The syndrome can affect people of all ages, but is most commonly found in infants, young children and people with developmental disabilities. In simple words, it is a feeding and eating disorder in which undigested food comes back up from a person’s stomach into their mouth, which is called regurgitation. This behaviour usually occurs after every meal and may appear effortless. In rumination, the food doesn’t tend to taste bitter or sour because it has not had time to fully mix with stomach acid and be digested.
Background and Recognition of Rumination Syndrome in Medical Literature
Rumination syndrome was first documented in medical literature in the early 20th century. It was initially considered a behavioural disorder, primarily affecting individuals with intellectual disabilities. Over the years, research and increased awareness led to a broader understanding of the condition, recognising its occurrence in otherwise healthy individuals. Despite the progress, rumination syndrome remains underdiagnosed. It is also frequently misinterpreted as other gastrointestinal disorders. These disorders most commonly include gastroesophageal reflux disease (GERD), gastroparesis or even bulimia nervosa due to the similarity in symptoms like regurgitation, which can be misinterpreted as vomiting. This often leads to incorrect diagnosis and treatment plans unless a detailed medical history is taken.
Difference from Other Digestive Disorders
Rumination syndrome is often confused with conditions such as vomiting disorders and gastroesophageal reflux disease (GERD). What differentiates rumination syndrome from other digestive disorders is the absence of nausea and the effortless nature of regurgitation. Unlike GERD, regurgitation in rumination syndrome is voluntary and caused by acid reflux.
Signs and Symptoms of Rumination Syndrome
Below are a few signs and symptoms of rumination syndrome:
Digestive problems such as stomach aches and indigestion
Weight loss
Chapped lips
Regurgitating and re-chewing food on a regular basis
Dental problems such as bad breath and tooth decay
Babies with rumination syndrome may strain or arch their backs (which could also be a sign of gastroesophageal reflux) or make sucking noises with their mouths.
Causes and Risk Factors of Rumination Syndrome
Although the exact cause of rumination syndrome is not clear, it seems linked to an increase in abdominal pressure. However, below are a few potential causes and risk factors associated with rumination syndrome:
1. Potential Genetic Predispositions
Although exact genetic factors influencing rumination syndrome are not fully understood, some studies suggest a hereditary component. A family history of gastrointestinal disorders or psychological conditions may increase susceptibility to the syndrome.
2. Behavioural and Psychological Components
Rumination syndrome is often linked to behavioural and psychological factors. Anxiety, stress and emotional disturbances can contribute to the onset and exacerbation of symptoms. In some cases, the behaviour may develop as a coping mechanism in response to environmental factors or psychological distress.
3. Age and Demographic Considerations
Rumination syndrome can impact people from across all age groups. However, it is more commonly diagnosed in infants, young children and adolescents. Adults also may develop the condition because of stress or underlying psychological issues.
Diagnosis of Rumination Syndrome
As mentioned below, a few tests and assessments can be done to diagnose rumination syndrome. The diagnosis primarily relies on a thorough medical history and observation of symptoms.
pH Monitoring: This helps in ruling out acid reflux as the cause of symptoms.
Gastric Emptying Studies: This helps in assessing how quickly food moves from the stomach to the small intestine.
Oesophageal Manometry: This helps in measuring the pressure and coordination of oesophageal muscle during swallowing.
Upper Gastrointestinal Endoscopy: This helps in examining the oesophagus and stomach lining to exclude structural abnormalities.
Complications that may be caused by Rumination Syndrome
There could be a few complications due to chronic regurgitation, as mentioned below:
1. Physical Complications
Physical complications due to chronic regurgitation may lead to malnutrition and weight loss, resulting from inadequate nutrient absorption. It can lead to dental erosion caused by frequent exposure to stomach acids. It can also lead to the inflammation of the oesophagus due to repeated irritation.
2. Psychological Complications
Anxiety and depression can be common psychological issues in individuals struggling with chronic health conditions. Some may feel social withdrawal due to embarrassment or fear of regurgitation in public. Rumination syndrome can co-occur with eating disorders like anorexia or bulimia.
Treatment Options for Rumination Syndrome
Rumination syndrome can be treated by following the below-mentioned treatment approaches:
1. Dietary Modifications and Management Strategies
One must ensure to follow certain diet modifications to better control the syndrome, such as:
Taking smaller and more frequent meals can reduce the likelihood of regurgitation.
Identifying and eliminating foods that exacerbate the syndrome.
Ensuring adequate caloric intake to prevent malnutrition.
2. Pharmacological Treatments
Though medication is not the primary treatment for rumination syndrome, certain drugs can help manage associated symptoms, such as:
Antidepressants or anxiolytics for addressing co-existing psychological conditions.
Prokinetic agents that can help in enhancing gastrointestinal motility.
3. Behavioural Therapy Approaches
The below approaches can also help better the syndrome:
Biofeedback Therapy utilises visual or auditory feedback to help patients gain control over their involuntary bodily functions.
Cognitive-behavioural Therapy (CBT) helps in addressing underlying psychological factors contributing to the condition.
Diaphragmatic breathing techniques help in encouraging the use of abdominal muscles to prevent regurgitation.
Impact on Quality of Life
While rumination syndrome is not life-threatening, the issues that may develop around the rumination can be quite debilitating. Some of these challenges include:
Greater risk for dehydration, weight loss and malnutrition.
No participation in sports or athletic activities, resulting in physical deconditioning.
Emotional struggles with depression, anxiety, and stress.
Heightened GI sensitivity which may result in severe abdominal pain, nausea, bloating, or pressure that makes having food or fluid in the stomach intolerable.
Prognosis and Long-term Outlook
With the right treatment, individuals may experience significant improvement or complete resolution of symptoms of rumination syndrome. Early intervention, particularly behavioural therapy, is key to successful outcomes.
Below are a few factors that may influence the outcomes:
Addressing co-existing mental health issues can contribute to overall well-being.
Consistent practise of behavioural techniques can enhance outcomes.
Early diagnosis and intervention can improve the likelihood of successful treatment.
Conclusion
Rumination syndrome, though a rare condition and often misunderstood, can significantly impact an individual’s quality of life. Through increased awareness, appropriate and accurate diagnosis and effective treatment strategies, patients can achieve relief from symptoms and lead healthier lives. Thus, early intervention and diagnosis are crucial with behavioural therapies combined with psychological support and dietary management. This plays a significant role in recovery from rumination syndrome. Ongoing research continues to shed light on this complex condition, offering people hope for more effective and refined treatments in the future. By fostering understanding and support, both healthcare providers and families can contribute to better outcomes for those affected by rumination syndrome.
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