Rumination Syndrome

Rumination syndrome is a rare disorder that causes you to regurgitate your food shortly after swallowing it. This may occur within minutes or up to two hours after eating. When it occurs, the undigested food comes back up from your stomach into your mouth. You may chew it and swallow it again, or you may spit it out. This pattern occurs repeatedly — generally, after every meal.

Why this happens is still something of a mystery. Rumination syndrome is automatic, and often unconscious. It’s not the same thing as throwing up: It doesn’t happen because you feel sick or forced to regurgitate. It’s not painful. Instead, it’s more of a reflex, like burping. Somehow, your body learns to relax the muscular valve that usually keeps food in your stomach. And once it learns, it becomes a habit.

Symptoms of rumination syndrome

Rumination syndrome is a pattern of regurgitation (food coming back up) after you eat. It’s typically painless and effortless. You might have a feeling like belching when it happens. It doesn’t involve nausea or retching. The regurgitated food doesn’t taste sour like vomit does. It hasn’t been in your stomach long enough to mix with the acid.

However, some people report:

• Separate episodes of vomiting or acid reflux
• Coexisting abdominal pain or indigestion
• A feeling of pressure before regurgitation, which may be painful

Babies who have rumination syndrome may arch their backs or make sucking noises.

Rumination syndrome causes

Researchers don’t fully understand what causes rumination syndrome. Some describe it as a functional GI disorder, and others as a behavioral disorder. Regurgitation can be learned and intentional or unintentional. Some believe it might be a learned response to a physical or psychological condition.

Mechanically speaking, regurgitation happens because certain muscles relax or contract at the wrong time. Your lower esophageal sphincter (LES) is the muscular valve between your esophagus and stomach. It’s supposed to open when you swallow and then close to keep food down in your stomach.

But in rumination syndrome, it doesn’t work this way. It appears that pressure within your belly triggers your abdominal muscles to contract, pushing food back up. At the same time, your LES relaxes in response to this internal pressure, like a release valve, allowing the food to continue to rise.

Risk factors

Rumination disorder occurs frequently in babies and in people with developmental disabilities. In these cases, it might be more of a physical coordination problem. But it can also occur in children and adults of all ages and without known disorders. In these cases, you might be more likely to develop it during times of stress. Many people report that they developed the behavior following a very stressful life event.

Risk factors include:

• Developmental delay
• Emotional stress
• Fibromyalgia or somatic pain
• Gastrointestinal disorders
• Infant emotional neglect
• Mental illness or another eating disorder

While rumination syndrome is rare overall, some studies suggest that as many as 1 in 10 people with fibromyalgia or with other eating disorders may experience it.

Complications of rumination syndrome

Complications related to rumination syndrome can include:

• Acid regurgitation and damage to your esophagus
• Aspiration, which can cause choking or pneumonia
• Dehydration and electrolyte imbalances
• Dental problems, like bad breath and tooth decay
• Weight loss, nutrient deficiencies or growth faltering in children
• Psychosocial issues, like shame and avoiding social interaction

How doctors diagnose rumination syndrome

Your healthcare provider may suspect rumination syndrome after an in-depth discussion of your symptoms and a brief exam. If they think you might have an underlying gastrointestinal disorder, they’ll check for that first with additional imaging or testing.

This might involve tests like:

• Esophagram
• Esophageal manometry test
• Gastric emptying study
• Upper endoscopy

The complete criteria for diagnosis, according to the Rome Foundation’s Rome IV Criteria, include:

• Persistent or recurrent regurgitation of recently ingested food into the mouth with subsequent sitting or rechewing and swallowing
• Regurgitation isn’t preceded by retching

Supporting evidence:

• Effortless regurgitation events aren’t preceded by nausea
• Regurgitation contains recognizable food, which may have a pleasant taste
• The process tends to stop when the regurgitated material becomes acidic

How is rumination syndrome treated?

Behavioral therapy is the primary treatment for rumination syndrome. With practice, you can learn to become aware of what’s happening in your body when you regurgitate. Then, you can choose a new response. Healthcare providers often prescribe diaphragmatic breathing exercises. With this technique, you practice relaxing and contracting your diaphragm as you breathe.

1. Lie on your back with your knees bent and your head supported. Place one hand on your upper chest and the other just below your rib cage on your belly.
2. Breathe in slowly through your nose, letting the hand on your belly move outward with it. Keep the hand on your chest as still as possible.
3. As you breathe out, purse your lips and tighten your stomach muscles. Keep the hand on your upper chest still as your other hand falls inward.

Other complementary therapies may include:

• Biofeedback
• Cognitive behavioral therapy (CBT)
• General relaxation techniques
• Reflux medications, like baclofen

When should I see my healthcare provider?

If you notice that you’re regurgitating after eating, it’s always better to interrupt the pattern sooner rather than later. You don’t need to wait for it to last three months or longer before you consult a healthcare provider or seek care. Eating disorders tend to worsen with time, and they can take longer to treat the longer they last. While a diagnosis can help, you don’t need a formal diagnosis to begin treatment.

What can I expect if I have rumination disorder?

Rumination syndrome isn’t a life-threatening disorder, as some eating disorders are. But it can have damaging side effects over time. It can encourage acid reflux and can also affect your quality of life. Behavioral therapy works well for most people with rumination syndrome. Even children can retrain their bodies and unlearn the behavior. If it involves another disorder, recovery may take a little longer.