Rumination Syndrome

Rumination Syndrome:

Rumination refers to the effortless regurgitation of undigested food back into the mouth, often shortly after eating. This is not the same as vomiting, which is forceful and often preceded by nausea. Rumination is a relatively rare condition, primarily affecting infants and young children, and can be linked to underlying medical issues or behavioral factors.

Rumination is a syndrome characterized by repetitive regurgitation of small amounts of food from the stomach. The food is then partially or completely rechewed, reswallowed, or expelled. This syndrome is relatively common in infants and mentally challenged persons, but it also occurs in adults with normal intelligence. The rumination syndrome is an underappreciated condition in adults who frequently receive a misdiagnosis of vomiting due to gastroparesis or gastroesophageal reflux. Difficulties in establishing the correct diagnosis may be caused by a lack of aware-ness of the condition among physicians. This syndrome must be considered in the differential diagnosis of a patient with regurgitation, vomiting (especially postprandial), and weight loss. Reassurance, explanations, and behavioral therapy are currently the mainstays of treatment in adults with normal intelligence who have the rumination syndrome. Appropriately controlled trials are needed to establish the best therapy.

INFANT RUMINATION SYNDROME

Rumination is well described in infants; the typical age at onset is between 3 and 6 months. The regurgitation is effortless and occurs without apparent distress to the infant. It does not occur during sleep or when the baby is actively interested in the surrounding environment. Other possible self-stimulating behaviors are moving the head, sucking on the hand, and making sounds. Physical consequences of rumination in this age-group can include malnutrition, weight loss, growth failure,

RUMINATION IN PERSONS WITH MENTAL RETARDATION

Rumination occurs in 6 to 10% of mentally challenged patients in institutions.These patients, however, have other causes of chronic regurgitation, including congenital anatomic defects (such as pharyngeal diverticula), medical disorders (such as inborn errors of metabolism or electrolyte imbalance), gastroesophageal reflux disease, poor gastric emptying, central nervous system diseases (such as hydrocephalus), and reactions to medications such as neuroleptics that have known side effects.

RUMINATION IN PATIENTS WITH BULIMIA NERVOSA

An association between rumination and bulimia nervosa has been previously described. In one study, 20% of patients with bulimia were found to ruminate; in another study, 17% of female ruminators had a history of bulimia. An important difference between ruminators who have bulimia and those who do not is that “bulimics” tend to expel rather than reswallow food and may self-induce vomiting by digital stimulation of the hypopharynx. In patients with bulimia, rumination may be a learned

RUMINATION IN ADULTS WITH NORMAL INTELLIGENCE

Rumination has recently been recognized to occur in adults with normal intelligence. The prevalence is unknown because many physicians are unaware of the condition. No characteristic psychiatric or psychologic profile exists. Occurrences in families have been reported, but a genetic association has not been established. Rumination may remain undiagnosed for months or years, and patients often undergo many unnecessary, expensive, and invasive tests. They may also receive total parenteral.