Merck Manual

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Rumination Disorder

By

Evelyn Attia

, MD, Columbia University Medical Center, New York State Psychiatric Institute;


B. Timothy Walsh

, MD, College of Physicians and Surgeons, Columbia University

Last full review/revision Jun 2020| Content last modified Jun 2020
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Rumination is repeated regurgitation of food after eating; the regurgitation does not involve nausea or retching and may be voluntary.

Patients with rumination disorder repeatedly regurgitate food after eating, but they have no nausea or involuntary retching. The food may be spit out or reswallowed; some patients rechew the food before reswallowing. Regurgitation occurs several times per week, typically daily.

Regurgitation disorder may occur in infants, children, adolescents, or adults.

The regurgitation is volitional (although patients may not be aware that they can control this behavior) and often can be directly observed by the clinician.

Some patients are aware that the behavior is socially undesirable and attempt to disguise it by putting a hand over their mouth or limiting their food intake. Some avoid eating with other people and do not eat before a social activity or work so that they do not regurgitate in public.

Patients who spit out the regurgitated material or who significantly limit their intake may lose weight or develop nutritional deficiencies.

Diagnosis

  • Clinical criteria

Rumination disorder is diagnosed when

  • Patients repeatedly regurgitate food over a period of ≥ 1 month.

  • Gastrointestinal (GI) disorders that can lead to regurgitation (eg, gastroesophageal reflux, Zenker diverticulum) or other eating disorders (eg, anorexia nervosa) in which rumination sometimes occurs have been excluded.

  • If regurgitation occurs in a patient with another disorder, it is severe enough to warrant specific treatment.

Clinicians may observe the regurgitation directly, or the patient may report it.

Clinicians also evaluate nutritional status to check for weight loss and nutritional deficiencies.

Treatment

  • Behavioral modification

Behavioral modification techniques, including treatments that use cognitive-behavioral strategies, may help.

Key Points

  • Regurgitation does not involve nausea or involuntary retching.

  • Some patients with rumination disorder are aware that the behavior is socially unacceptable and try to disguise or hide it.

  • Some limit how much they eat (to prevent others from seeing them regurgitate), sometimes resulting in weight loss or nutritional deficiencies.

  • Diagnose rumination disorder in patients who report repeatedly regurgitating food for ≥ 1 month after excluding other possible causes (eg, GI disorders, other eating disorders).

  • Treat using behavioral modification techniques.

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NOTE: This is the Professional Version. CONSUMERS: Click here for the Consumer Version

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