What Is Rumination Disorder?

Medically reviewed by Karen Gill, MD on December 11, 2017Written by Carly Vandergriendt on December 11, 2017

Overview

Rumination disorder, also known as rumination syndrome, is a rare and chronic condition. It affects infants, children, and adults.

People with this disorder regurgitate food after most meals. Regurgitation occurs when recently ingested food rises into the esophagus, throat, and mouth, but isn’t involuntarily or forcefully expelled from the mouth as it is in vomiting.

Symptoms

The main symptom of this disorder is the repeated regurgitation of undigested food. Regurgitation typically occurs between a half hour to two hours after eating. People with this condition regurgitate every day and after almost every meal.

Other symptoms may include:

  • bad breath
  • weight loss
  • stomach aches or indigestion
  • tooth decay
  • dry mouth or lips

Signs and symptoms of rumination disorder are the same in both children and adults. Adults are more likely to spit out regurgitated food. Children are more likely to rechew and reswallow the food.

Is rumination disorder an eating disorder?

Rumination disorder has been linked to other eating disorders, in particular bulimia nervosa, but how these conditions are related is still unclear. The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) identifies the following diagnostic criteria for rumination disorder:

  • Recurrent regurgitation of food for at least a one-month period. Regurgitated food may be spit out, rechewed, or reswallowed.
  • Regurgitation isn’t caused by a medical condition, such as a gastrointestinal disorder.
  • Regurgitation doesn’t always occur in relation to another eating disorder, such as anorexia nervosa, binge-eating disorder, or bulimia nervosa.
  • When regurgitation occurs alongside another intellectual or developmental disorder, symptoms are severe enough to require medical assistance.

Rumination disorder vs. reflux

Symptoms of rumination disorder are different from those for acid reflux and GERD:

  • In acid reflux, acid used to break down food in the stomach rises into the esophagus. That may cause a burning sensation in the chest and a sour taste in the throat or mouth.
  • In acid reflux, food is occasionally regurgitated, but it tastes sour or bitter, which is not the case with regurgitated food in rumination disorder.
  • Acid reflux more often occurs at night, particularly in adults. That’s because lying down makes it easier for the contents of the stomach to rise up the esophagus. Rumination disorder occurs shortly after the ingestion of food.
  • Symptoms of rumination disorder don’t respond to treatments for acid reflux and GERD.

Causes

Researchers don’t completely understand what causes rumination disorder.

Regurgitation is thought to be unintentional, but the action required to regurgitate is likely learned. For example, someone with rumination disorder may unknowingly never have learned how to relax their abdominal muscles. Contracting the diaphragm muscles can lead to regurgitation.

More research is needed to better understand this condition.

Risk factors

Rumination disorder can affect anyone, but it’s most commonly seen in infants and children with intellectual disabilities.

Some sources suggest rumination disorder is more likely to affect females, but additional studies are needed to confirm this.

Other factors that may increase the risk of rumination disorder in both children and adults include:

  • having an acute illness
  • having a mental illness
  • experiencing a psychiatric disturbance
  • undergoing major surgery
  • undergoing a stressful experience

More research is needed to identify how these factors contribute to rumination disorder.

Diagnosis

There’s no test for rumination disorder. Your doctor will perform a physical exam and ask you to describe you or your child’s symptoms and medical history. The more detailed your answers, the better. A diagnosis is mostly based on the signs and symptoms you describe. People with rumination disorder often don’t have other symptoms such as true vomiting or an acid sensation or taste in their mouth or throat.

Certain tests may be used to rule out other medical conditions. For instance, blood tests and imaging studies might be used to rule out gastrointestinal disorders. Your doctor may look for other signs of a problem, such as dehydration or nutritional deficiencies.

Rumination disorder is often misdiagnosed and mistaken for other conditions. More awareness is needed to help people with the condition and doctors identify symptoms.

Treatment

Treatment for rumination disorder is the same in both children and adults. Treatment focuses on changing the learned behavior responsible for regurgitation. Different approaches may be used. Your doctor will tailor the approach based on your age and abilities.

The simplest and most effective treatment for rumination disorder in children and adults is diaphragmatic breathing training. It involves learning how to breathe deeply and relax the diaphragm. Regurgitation cannot occur when the diaphragm is relaxed.

Apply diaphragmatic breathing techniques during and right after meals. Eventually, rumination disorder should disappear.

Other treatments for rumination disorder can include:

  • changes in posture, both during and right after a meal
  • removing distractions during meal times
  • reducing stress and distractions during meal times
  • psychotherapy

There is currently no medication available for rumination disorder.

Outlook

Diagnosing rumination disorder can be a difficult and lengthy process. Once a diagnosis has been made, the outlook is excellent. Treatment for rumination disorder is effective in the majority of people. In some cases, rumination disorder even goes away on its own.

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