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Rumination Syndrome: Recognition and Treatment

  • Neurogastroenterology and GI Motiliy (H Parkman and R Schey, Section Editors)
  • Published:
Current Treatment Options in Gastroenterology Aims and scope Submit manuscript

Abstract

Purpose of review

The purpose of this paper is to discuss current diagnostic and treatments of rumination.

Rumination is often underdiagnosed or misdiagnosed in adults, especially when symptoms suggest regurgitation rather than vomiting accompanied by re-chewing and re-swallowing and should be included in the differential diagnosis. It is primarily diagnosed clinically by ROME-IV or DSM-5.

Recent findings

That rumination can be re-affirmed by characteristic patterns on objective testing such as high-resolution esophageal manometry and 24-h pH impedance testing. However, although gastroduodenal manometry and EMG are helpful, these tests are slowly losing interest given their technical nature of data gathering, time consumption, cost burden, and patient discomfort.

Summary

Rumination is primarily diagnosed clinically by ROME-IV or DSM-5 in addition to high-resolution esophageal manometry and 24-h pH impedance. Management is challenging and usually a combination of behavioral, pharmacological, and rarely surgical treatment. Recent data demonstrate that the combination of behavioral techniques such as diaphragmatic breathing exercises and/or with baclofen has promising results. Further research is necessary to further define objective criteria for diagnosis and other therapeutic modalities for treatment.

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Author information

Authors and Affiliations

  1. Division of Gastroenterology, Department of Medicine, University of Florida College of Medicine-Jacksonville, Jacksonville, FL, USA

    Herit Vachhani & Ron Schey

  2. Neurogastroenterology & Esophageal Program, University of Florida College of Medicine-Jacksonville, Building 1, Suite 300, 4555 Emerson Street, Jacksonville, FL, 32207, USA

    Bruno De Souza Ribeiro & Ron Schey

Authors
  1. Herit Vachhani
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  2. Bruno De Souza Ribeiro
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  3. Ron Schey
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Corresponding author

Correspondence to Ron Schey.

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Conflict of interest

Herit Vachhani, Bruno De Souza Ribeiro, and Ron Schey declare no conflict of interest.

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Key Points

Rumination syndrome is defined as effortless postprandial regurgitation that patients may characterize as vomiting.

Diagnosis of rumination syndrome is clinical but supported by objective testing such as HREMI.

Treatment is primarily diaphragmatic breathing; however, baclofen has also showed nominal benefit.

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Vachhani, H., Ribeiro, B.D.S. & Schey, R. Rumination Syndrome: Recognition and Treatment. Curr Treat Options Gastro 18, 60–68 (2020). https://doi.org/10.1007/s11938-020-00272-4

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  • DOI: https://doi.org/10.1007/s11938-020-00272-4

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