(See also Introduction to Eating Disorders Introduction to Eating Disorders Eating disorders involve a persistent disturbance of eating or of behavior related to eating that Alters consumption or absorption of food Significantly impairs physical health and/or psychosocial... read more .)
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.
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 Gastroesophageal Reflux Disease (GERD) Incompetence of the lower esophageal sphincter allows reflux of gastric contents into the esophagus, causing burning pain. Prolonged reflux may lead to esophagitis, stricture, and rarely metaplasia... read more , Zenker diverticulum Esophageal Diverticula An esophageal diverticulum is an outpouching of mucosa through the muscular layer of the esophagus. It can be asymptomatic or cause dysphagia and regurgitation. Diagnosis is made by barium swallow... read more ) or other eating disorders (eg, anorexia nervosa) Anorexia Nervosa Anorexia nervosa is characterized by a relentless pursuit of thinness, a morbid fear of obesity, a distorted body image, and restriction of intake relative to requirements, leading to a significantly... read more 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.
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.