What is rumination eating disorder?

Characteristic feature of rumination disorder

Rumination disorder is a rare eating disorder that causes the involuntary regurgitation of recently consumed food [1]. Typically, about 10 to 15 minutes after eating, undigested food rises back into the mouth from the esophagus, and this can last for 1 to 2 hours[1]. The individual may either chew and swallow the food again or spit it out. This reflexive action is not under conscious control and may occur after every meal[1].

Comparison of rumination disorder to other conditions (belching, throwing up)

Experts believe that rumination occurs unconsciously, yet they also suggest that the voluntary relaxation of the diaphragm muscles may develop into a learned habit[1]. This reflex is akin to the usual belching process, but instead of releasing gas, it causes food to be regurgitated[1]. Rumination differs from vomiting in that the regurgitated food remains undigested and typically retains its original taste, similar to when it was first consumed[1]. Vomiting is much more prevalent, which often leads to rumination syndrome being incorrectly diagnosed as a vomiting-related disorder, such as delayed digestion (gastroparesis) or acid reflux (GERD or gastroesophageal reflux disease)[1]. It is also confused with bulimia nervosa eating disorder [2]. To accurately diagnose rumination, healthcare providers must ask specific questions, such as inquiring about the taste of the regurgitated food[1]. If the food still tastes pleasant, it indicates that digestion has not occurred, suggesting rumination syndrome is a likely diagnosis[1]. In contrast, vomited food is usually digested and tastes acidic[1 and 2]. The symptoms of rumination syndrome do not improve with standard reflux treatments[1].

Treatment of rumination disorder

No medications are effective in treating rumination syndrome at present [1]. The most effective approach is to relearn proper eating and digestion techniques, which include diaphragmatic breathing[1].

Causes of rumination disorder

Experts are uncertain about the initial causes of rumination syndrome, making it difficult to determine effective prevention methods[1]. However, it seems to be triggered by a rise in abdominal pressure [2].

Risk factors of rumination disorder

1. Emotional neglect of infants

2. Emotional stress [3]

3. Mental disorders such as obsessive-compulsive disorder, anxiety, depression, adjustment disorder, post-traumatic stress disorder, and attention deficit disorder (ADHD) [4][5][6]

4. Developmental delay

5. Fibromyalgia [7]

6. Rectal evacuation disorder [8]

   
   

Physical symptoms of rumination disorder

The positive aspect of rumination syndrome is that it typically doesn’t cause significant physical harm[1]. However, in rare instances, it can lead to issues with the esophagus due to acid and reflux, and in some teenagers and adults, it has resulted in slight weight loss[1].

Symptoms of rumination disorder

1. Involuntary regurgitation usually occurs within minutes of eating [2].

2. Abdominal pain or pressure that eases after regurgitation [2]

3. A sensation of fullness [2].

4. Nausea [2].

5. Unintentional weight loss [2].

Prevalence of rumination disorder

Rumination disorder is most common in children[1]. The condition has been recognized for a long time as occurring in infants and individuals with developmental disabilities [2]. Rumination syndrome is also more common in those with anxiety, depression, or other psychiatric disorders [2].

Complications of rumination disorder

1. Unhealthy weight loss [2]

2. Nutritional deficiencies [2].

3. Tooth erosion [2]

4. Unpleasant breath [2].

5. Feelings of embarrassment [2].

6. Withdrawal from social interactions [2].

References

1. Rumination syndrome. (2024, April 29). Johns Hopkins Medicine. https://www.hopkinsmedicine.org/health/conditions-and-diseases/rumination-syndrome

2. Rumination syndrome - Symptoms and causes - Mayo Clinic. (2023, October 20). Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/rumination-syndrome/symptoms-causes/syc-20377330

3. Malcolm, A., Thumshirn, M. B., Camilleri, M., & Williams, D. E. (1997). Rumination syndrome. Mayo Clinic Proceedings, 72(7), 646-652.

4. Levine, D. F., Wingate, D. L., Pfeffer, J. M., & Butcher, P. (1983). Habitual rumination: A benign disorder. British Medical Journal (Clinical Research Edition), 287(6387), 255-256.

5. Halland, M., Parthasarathy, G., Bharucha, A. E., & Katzka, D. A. (2016). Diaphragmatic breathing for rumination syndrome: Efficacy and mechanisms of action. Neurogastroenterology & Motility, 28(3), 384-391.

6. Barba, E., Burri, E., Accarino, A., Malagelada, C., Rodriguez-Urrutia, A., Soldevilla, A., Malagelada, J. R., & Azpiroz, F. (2015). Biofeedback-guided control of abdominothoracic muscular activity reduces regurgitation episodes in patients with rumination. Clinical Gastroenterology and Hepatology, 13(1), 100-106.e1.

7. Almansa, C., Rey, E., Sánchez, R. G., Sánchez, A. A., & Díaz-Rubio, M. (2009). Prevalence of functional gastrointestinal disorders in patients with fibromyalgia and the role of psychological distress. Clinical Gastroenterology and Hepatology, 7(4), 438-445.

8. Vijayvargiya, P., Iturrino, J., Camilleri, M., Shin, A., Vazquez-Roque, M., Katzka, D. A., Snuggerud, J. R., & Seime, R. J. (2014). Novel association of rectal evacuation disorder and rumination syndrome: Diagnosis, co-morbidities, and treatment. United European Gastroenterology Journal, 2(1), 38-46.