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Rumination syndrome is effortless and persistent or repetitive, regurgitation of recently consumed food back from the stomach into mouth. It is considered among one of the functional gastrointestinal disorders and is defined by Rome III criteria.
Who may suffer from rumination syndrome?
It was initially described in mentally and developmentally challenged children. Although normal in cows and other animals, rumination is not a part of healthy digestion process in humans. It may be seen in healthy subjects of all ages including adults irrespective of cognitive function.
What causes rumination syndrome?
Causation is poorly understood. Basically, it is a learned behavior/disorder, a reflex response, and not an intentional action. There is a voluntary although unintentional contraction of abdominal muscles raising the pressure in stomach and regurgitating the food upstream up the esophagus and into the mouth.
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Clinical manifestations of rumination syndrome
The rumination or regurgitation episode typically occurs 1-2 hours after meals. The food arriving into the mouth is either spitted out or reswallowed. The event is not preceded by retching or nausea. The regurgitated food is easily recognized and tastes just fine. The event stops once the regurgitate tastes acidic.
Diagnosis of rumination syndrome
Diagnosis is mainly clinical. A good history is the cornerstone of diagnosis. Manometry may aid diagnosis but is not esential and is performed in specialized centers only.
Difference between vomiting and rumination syndrome
Rumination different from vomiting. The process is volatile. The food regurgitated into mouth cannot be retained in a vomiting episode. In contrast, the food can be retained the mouth in a rumination episode, and is subsequently spitted or re-swallows.
Treatment of rumination syndrome
1. Reassurance plus behavioral therapy is succesful in as many as 90% of patients
2. Behavioral therapy includes habit reversal techniques involving unlearning of the learned behaviors. Since rumination cannot occur during relaxed diaphragm, patients are given diaphragmatic rebreathing training wherein patients relax their diaphragm during and after meals. This is easily learnt, performed and is highly effective.
3. Chewing gum helps.
4, Medications: Prokinetic agents, baclofen may be tried, however, there is lack of studies
5. Surgery: Anti-reflux surgery
Efficacy of medicinal and surgical treatments has not been well studied and likely not effective not of value.
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Long term consequences of rumination
- Mostly nuisance value
- No long term health consequences in most cases
- Few patients develop esophagitis (inflammation of esophagus)
- Weight loss is uncommon
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Wall Street Journal Best Seller Dr. M's Seven-X Plan for Digestive Health