Rumination Syndrome: A Lesser-Known Eating Disorder

Rumination is a reflex action characterized by the regurgitation of chewed food that enters the food pipe.

Upon eating, the undigested food comes back into the mouth either immediately or within 30 mins to 2 hours of swallowing the food. The person then either re-chews and re-swallows it or spits it out.

Rumination disorder mostly affects young children, adolescents, and sometimes adults as well.

What causes rumination disorder?

Rumination is an unconscious action without any physical abnormality. But, it is believed that this disorder makes the diaphragm relax voluntarily that eventually becomes a learned habit.

Unlike the belching reflex that makes people burp out gas, rumination disorder causes the backflow of food into the mouth.

Rumination disorder in children is more prevalent in the ones with developmental disabilities.

Studies also show that certain illnesses, gastrointestinal diseases, or stress can trigger rumination symptoms. It may lead to increased sensitivity in the digestive tract.

Even if this trigger is resolved, the regurgitation reflex might become habitual.

Diagnosis of rumination disorder

Rumination syndrome is "not rare but rarely diagnosed".

Rumination is mistaken for vomiting. In the case of rumination, the food is undigested, and patients can retain the food in the mouth. But in vomiting, the food is forcefully ejected and thus cannot be retained. The main characteristic of rumination syndrome is regurgitating food and eating it again.

Symptoms vary as some people experience pain while eating, whereas some are pain-free. Some people may change their eating habits and food choices to avoid regurgitation. Some may have nausea.

It is crucial to know what the food tastes like after regurgitation and how long after eating does regurgitation happen.

Doctors can distinguish rumination from other GI disorders based on the following factors:

  1. The food tastes normal when it comes back up into the mouth.
  2. No regurgitation during sleep.
  3. No retching involved.
  4. Rumination is not a consequence of any gastrointestinal or other eating disorders.

Studies show that some infants find pleasure in rumination. However, adults with rumination disorder tend to avoid eating in front of others due to feelings of shame.

Rumination syndrome occurs in about 6-10% of people with mental disabilities. It is associated with anxiety and depression.

However, it is difficult to ascertain the prevalence of rumination in people with ordinary intelligence because they are either misdiagnosed or tend to hide their condition.

Complications of rumination disorder

Unlike other eating disorders, rumination does not seem to have a severe impact on the physical health of a patient. Most people who have had this condition for a long time appear to be healthy.

However, some of the complications associated with rumination may include:

  1. Stomach pain
  2. Indigestion
  3. Damage to the food pipe
  4. Weight loss
  5. Dehydration
  6. Malnutrition
  7. Emotional issues
  8. Slow growth
  9. Developmental and learning difficulties
  10. Social withdrawal.

Related: Pica Disorder: Eating Everything Except Food

Rumination syndrome treatment

Since rumination disorder is behavioral, it can be “unlearned.”

Treatment mostly involves behavioral therapies. Therapists will teach you how to relax the diaphragm during and after meals, re-breathing techniques, and learn how to eat and digest food correctly to avoid regurgitation.

There are no medications available to treat rumination. But, medicines can help ease the esophagus and stomach after eating.

Nutritional rehabilitation depends on the symptoms, weight, and growth of a person. A therapist will teach the child several techniques to keep the food down and ask to practice the same regularly.

Mental health awareness and therapy will help to expand the understanding of rumination disorder.

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