Rumination Syndrome

Rumination syndrome, or rumination disorder, is a rare condition that causes you to bring up (regurgitate) food shortly after swallowing it. This may occur within minutes or up to two hours after eating.

When it happens, 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 takes place over and over again — usually after every meal.

Why this happens is still something of a mystery. Rumination syndrome is automatic. You often regurgitate without thinking about it. It’s not the same thing as throwing up. It doesn’t happen because you feel sick or forced to bring up your food. 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 bringing food 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.

But some people report:

• Separate episodes of vomiting or acid reflux
• Belly pain or indigestion
• A feeling of pressure before the food comes back up, which may be painful

Babies who have rumination disorder 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 gastrointestinal (GI) disorder. Others call it a behavioral disorder. Regurgitation can be learned. It can be intentional or unintentional. Some believe it might be a learned response to a physical or psychological condition.

In general, regurgitation happens because certain muscles relax or squeeze (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. Instead, 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. It’s like a release valve, allowing the food to continue to rise.

Risk factors

Rumination disorder occurs frequently in babies. It also commonly affects people with developmental disabilities. In these cases, it might be more of a problem with physical coordination.

But it can also happen 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
• GI disorders
• Infant emotional neglect
• Mental health condition
• Another eating disorder

Rumination syndrome is rare overall. But some studies suggest that as many as 1 in every 10 people with another eating disorder or fibromyalgia may have 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, a lack of nutrients or growth faltering in children
• Psychosocial issues, like shame and avoiding social interaction

How doctors diagnose rumination syndrome

Your healthcare provider will ask about your symptoms and do an exam. If they think you might have an underlying GI disorder, they’ll check for that first with other 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:

• You persistently or repeatedly bring up recently ingested food into your mouth. This is followed by spitting or rechewing and swallowing.
• You don’t dry heave before the food comes up.
• Regurgitation contains recognizable food, which may have a pleasant taste.
• The process tends to stop when the regurgitated food becomes acidic.

How do you treat rumination syndrome?

The main rumination syndrome treatment involves behavioral therapy. With practice, you can learn to become aware of what’s happening in your body when you bring up food. Then, you can choose a new response.

Healthcare providers often prescribe diaphragmatic breathing for rumination syndrome. With this technique, you practice relaxing and squeezing (contracting) your diaphragm as you breathe. The steps are:

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 therapies may include:

• Biofeedback
• Cognitive behavioral therapy (CBT)
• General relaxation techniques

Your provider may also prescribe a reflux medication, like baclofen.

When should I see my healthcare provider?

If you notice that you’re bringing up food after eating, it’s always better to stop the pattern sooner rather than later. You don’t need to wait for it to last three months or longer before you talk to your healthcare provider or seek care.

Eating disorders tend to worsen with time. They can take longer to treat the longer they last. A diagnosis can help. But 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 it 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.