Rumination is repeated regurgitation of food after eating; the regurgitation may be voluntary and is not due to nausea or involuntary retching.
Patients with rumination disorder repeatedly regurgitate food after eating, but they have no nausea or involuntary retching. The food may be spit out or re-swallowed; some patients rechew the food before re-swallowing. The regurgitation can be intentional or unintentional and often can be directly observed by the clinician. Regurgitation occurs several times per week, typically daily (1).
Regurgitation disorder may occur in infants, children, adolescents, or adults. It is described both as a psychiatric feeding and eating disorder by the Diagnostic and Statistical Manual of Mental Disorders, 5th ed,Text Revision (DSM-5-TR), as well as a gastroduodenal disorder of gut-brain interaction by the Rome Foundation, an organization that supports research and education about such interactions (2, 3).
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.
References
1. Absah I, Rishi A, Talley NJ, Katzka D, Halland M. Rumination syndrome: pathophysiology, diagnosis, and treatment. Neurogastroenterol Motil. 2017;29(4):10.1111/nmo.12954. doi:10.1111/nmo.12954
2. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed, Text Revision. American Psychiatric Association Publishing; 2022:374-375.
3. Drossman DA. Functional Gastrointestinal Disorders: History, Pathophysiology, Clinical Features and Rome IV. Gastroenterology. Published online February 19, 2016. doi:10.1053/j.gastro.2016.02.032
Diagnosis of Rumination Disorder
Psychiatric assessment
Rumination disorder is diagnosed when the following Diagnostic and Statistical Manual of Mental Disorders, 5th ed, Text Revision (DSM-5-TR) criteria are met (1):
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 feeding and 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.
Diagnosis reference
1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed, Text Revision. American Psychiatric Association Publishing; 2022:374-375.
Treatment of Rumination Disorder
Behavioral modification
Behavioral modification techniques, including biofeedback-guided diaphragmatic breathing as well as cognitive behavioral strategies, may help (1).
Treatment reference
1. Murray HB, Juarascio AS, Di Lorenzo C, Drossman DA, Thomas JJ. Diagnosis and Treatment of Rumination Syndrome: A Critical Review. Am J Gastroenterol. 2019;114(4):562-578. doi:10.14309/ajg.0000000000000060
Key Points
Rumination is repeated regurgitation of food after eating but 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 feeding and eating disorders).
Treat using behavioral modification techniques.
