Rumination disorder: Difference between revisions

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__NOTOC__
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{{SI}}
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{{CMG}}; {{AE}} Mark Warren, M.D., M.P.H.; Fellow, Academy of Eating Disorders [mailto:mwarren@eatingdisorderscleveland.org]; {{KS}} ; {{VSRN}}
{{CMG} ; {{AE}} Mark Warren, M.D., M.P.H.; Fellow, Academy of Eating Disorders [mailto:mwarren@eatingdisorderscleveland.org];{{VSRN}}; {{KS}}


{{SK}} Childhood rumination disorder; merycism, rumination syndrome
{{SK}} Childhood rumination disorder; merycism, rumination syndrome
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Rumination is an [[eating disorder]] characterized by having the contents of the [[stomach]] drawn back up into the [[mouth]], chewed for a second time, and [[swallowing|swallowed]] again.  In some animals, known as [[ruminant]]s, this is a natural and healthy part of [[digestion]] and is not considered an eating disorder. However, in other species (including humans), such behavior is atypical and potentially dangerous as the [[esophagus]] can be damaged by frequent exposure to [[stomach]] acids.  Rumination is also associated with eating disorders such as anorexia nervosa, and can be the result of one's apprehension and nervousness after eating a normal meal. For those with purging behaviors, rumination can take place when the option of getting rid of a meal via throwing up is not available (thus, one might feel worried and visibly upset).  Rumination has also been reported in developmentally normal children and adults who experience regurgitation of previously swallowed food, without disgust, nausea or an acidic taste. The food is either chewed and reswallowed or spat out. Remission of these episodes is seen in some cases while others persist. Many claim this as a pleasurable habit.
Rumination is an [[eating disorder]] characterized by having the contents of the [[stomach]] drawn back up into the [[mouth]], chewed for a second time, and [[swallowing|swallowed]] again.  In some animals, known as [[ruminant]]s, this is a natural and healthy part of [[digestion]] and is not considered an eating disorder. However, in other species (including humans), such behavior is atypical and potentially dangerous as the [[esophagus]] can be damaged by frequent exposure to [[stomach]] acids.  Rumination is also associated with eating disorders such as anorexia nervosa, and can be the result of one's apprehension and nervousness after eating a normal meal. For those with purging behaviors, rumination can take place when the option of getting rid of a meal via throwing up is not available (thus, one might feel worried and visibly upset).  Rumination has also been reported in developmentally normal children and adults who experience regurgitation of previously swallowed food, without disgust, nausea or an acidic taste. The food is either chewed and reswallowed or spat out. Remission of these episodes is seen in some cases while others persist. Many claim this as a pleasurable habit.


==Differential Diagnosis==
 
==[[ Rumination disorderhistorical perspective|Historical Perspective , Epidemiology and Demographics]]==
 
prevalence: Both adults and children are susceptible to rumination syndrome. Out of the 2163 children and adolescents questioned for this study, 110 (5%) met the clinical criteria for rumination syndrome. In one research conducted in the United States, the prevalence of rumination was 5.8 percent <ref name="PMID:34774539.">{{cite journal |vauthors=Josefsson A|title= Global Prevalence and Impact of Rumination Syndrome Eur J Brain Pathol. Neurology.  |PMID= 34774539.|url=}}</ref>
; in another, almost 50,000 individuals were questioned in 26 nations. Rumination syndrome may affect as many as 7 to 8 percent of people with fibromyalgia or eating problems.<ref name="PMID:19138763.">{{cite journal |vauthors=Almansa C|title= Prevalence of functional gastrointestinal disorders in patients with fibromyalgia and the role of psychologic distress Eur J Brain Pathol. Neurology.  |PMID= 19138763.|url=}}</ref> Related disorders: Constipation from a rectal evacuation disorder, anxiety, depression, adjustment disorder, obsessive compulsive disorder, post-traumatic stress disorder, and attention deficit-hyperactivity disorder have all been linked to rumination syndrome. While some research indicates that adults and adolescents with developmental delays are more likely to experience rumination syndrome
 
 
==[[ Rumination disorderpathophysiology|Pathophysiology]]==
 
Although the exact cause of rumination syndrome is unknown, one important pathogenetic characteristic that seems to be present is unperceived abdominal wall activity throughout the postprandial interval. Although the precise cause of this activation of the abdominal wall is unknown, given the similarities between rumination syndrome and functional dyspepsia, it is plausible that postprandial dyspeptic symptoms are the trigger for rumination episodes.<ref name="PMID:34626489.">{{cite journal |vauthors=Zand Irani M|title= Prevalence, symptoms and risk factor profile of rumination syndrome and functional dyspepsia: a population-based study Eur J Brain Pathol. Neurology.  |PMID= 34626489.|url=}}</ref>
 
In individuals with rumination syndrome, a permissive esophagogastric gradient is created by a combination of elevated intra-abdominal pressure and negative intrathoracic pressure, which causes the retrograde flow of eaten gastric material into the mouth. Rumination occurs after stomach pressurizations surpassing 30 mmHg on postprandial esophageal high resolution impedance manometry. This is linked to lower and upper esophageal relaxation during the gastric pressurization. This suggests that malfunctioning of the upper and lower esophageal sphincters is probably involved in rumination and that elevated intra-abdominal pressure alone is not sufficient to explain it.<ref name="PMID:26661735.">{{cite journal |vauthors=Halland M|title= Diaphragmatic breathing for rumination syndrome: efficacy and mechanisms of action. Neurogastroenterol Motil Eur J Brain Pathol. Neurology.  |PMID= 26661735.|url=}}</ref>
 
It is believed that the activation of the muscles in the abdominal wall is what causes this surge in intraluminal pressure. During electromyography recordings, postprandial abdominal wall activity has also been noted; this activation is correlated with bouts of regurgitation. <ref name="PMID:27185077..">{{cite journal |vauthors=Barba E|title= Randomized, Placebo-Controlled Trial of Biofeedback for the Treatment of Rumination Eur J Brain Pathol. Neurology.  |PMID= 27185077.|url=}}</ref> <ref name="PMID:24768808">{{cite journal |vauthors=Barba E|title= Biofeedback-guided control of abdominothoracic muscular activity reduces regurgitation episodes in patients with rumination.  |PMID= 24768808|url=}}</ref>
 
 
==[[ Rumination disordercauses|Clinical features]]==
 
The hallmark of rumination syndrome is fast regurgitation, typically starting within ten minutes of meal completion. Episodes often last for one to two hours following the meal, and the regurgitant is made up of partly digested food that tastes similar to what was really swallowed. Easy to perform, regurgitation is frequently caused by an abdominal ache, pressure, or burning feeling that has to be eased.
 
Retching is not typically seen before an episode. Consciously, the content is regurgitated or reabsorbed. Regurgitation happens usually, if not always, after eating. In order to make up for this, patients frequently modify their eating habits and may stop eating in public.
 
Patients often express nausea and dyspepsia symptoms such as burning or fullness in the stomach, and there is almost a four-fold increased likelihood of overlap between rumination syndrome and functional dyspepsia than would be predicted by chance. It is unusual to have overt discomfort. About 20 to 40 percent of patients have shown signs of weight reduction. In the absence of a co-occurring eating problem, significant weight loss, electrolyte imbalances, tooth erosions, and malnutrition are uncommon. <ref name="PMID:27185077">{{cite journal |vauthors=Barba E|title= Randomized, Placebo-Controlled Trial of Biofeedback for the Treatment of Rumination.  |PMID=  27185077.|url=}}</ref> <ref name="PMID:26661735.">{{cite journal |vauthors=Halland M|title= Diaphragmatic breathing for rumination syndrome: efficacy and mechanisms of action. Neurogastroenterol Motil.  |PMID=  26661735.|url=}}</ref> <ref name="PMID:23173868.">{{cite journal |vauthors=Tucker E|title= Rumination variations: aetiology and classification of abnormal behavioural responses to digestive symptoms based on high-resolution manometry studies.  |PMID= 23173868.|url=}}</ref> 
 
==[[ Rumination disorderdifferential diagnosis|Differentiating  Rumination disorderfrom other Diseases]]==
 
Rumination syndrome should be differentiated from other diseases that cause chronic [[nausea and vomiting]]. The differentials include the following:<ref name="pmid25667023">{{cite journal |vauthors=Parkman HP |title=Idiopathic gastroparesis |journal=Gastroenterol. Clin. North Am. |volume=44 |issue=1 |pages=59–68 |year=2015 |pmid=25667023 |pmc=4324534 |doi=10.1016/j.gtc.2014.11.015 |url=}}</ref><ref name="pmid17015559">{{cite journal |vauthors=Werlin SL, Fish DL |title=The spectrum of valproic acid-associated pancreatitis |journal=Pediatrics |volume=118 |issue=4 |pages=1660–3 |year=2006 |pmid=17015559 |doi=10.1542/peds.2006-1182 |url=}}</ref><ref name="pmid16369243">{{cite journal |vauthors=Noddin L, Callahan M, Lacy BE |title=Irritable bowel syndrome and functional dyspepsia: different diseases or a single disorder with different manifestations? |journal=MedGenMed |volume=7 |issue=3 |pages=17 |year=2005 |pmid=16369243 |pmc=1681633 |doi= |url=}}</ref><ref name="pmid23226859">{{cite journal |vauthors=Gupta R, Kalla M, Gupta JB |title=Adult rumination syndrome: Differentiation from psychogenic intractable vomiting |journal=Indian J Psychiatry |volume=54 |issue=3 |pages=283–5 |year=2012 |pmid=23226859 |pmc=3512372 |doi=10.4103/0019-5545.102434 |url=}}</ref><ref name="urlBody weight in bulimia nervosa | SpringerLink">{{cite web |url=https://link.springer.com/article/10.1007/BF03339730 |title=Body weight in bulimia nervosa &#124; SpringerLink |format= |work= |accessdate=}}</ref><ref name="pmid25904280">{{cite journal |vauthors=Sağlam F, Sivrikoz E, Alemdar A, Kamalı S, Arslan U, Güven H |title=Bouveret syndrome: A fatal diagnostic dilemma of gastric outlet obstruction |journal=Ulus Travma Acil Cerrahi Derg |volume=21 |issue=2 |pages=157–9 |year=2015 |pmid=25904280 |doi= |url=}}</ref><ref name="pmid21475419">{{cite journal |vauthors=Talley NJ |title=Rumination syndrome |journal=Gastroenterol Hepatol (N Y) |volume=7 |issue=2 |pages=117–8 |year=2011 |pmid=21475419 |pmc=3061016 |doi= |url=}}</ref><ref name="pmid15067630">{{cite journal |vauthors=Tutuian R, Castell DO |title=Rumination documented by using combined multichannel intraluminal impedance and manometry |journal=Clin. Gastroenterol. Hepatol. |volume=2 |issue=4 |pages=340–3 |year=2004 |pmid=15067630 |doi= |url=}}</ref><ref name="pmid24921208">{{cite journal |vauthors=Kessing BF, Smout AJ, Bredenoord AJ |title=Current diagnosis and management of the rumination syndrome |journal=J. Clin. Gastroenterol. |volume=48 |issue=6 |pages=478–83 |year=2014 |pmid=24921208 |doi=10.1097/MCG.0000000000000142 |url=}}</ref><ref name="pmid19232280">{{cite journal |vauthors=Parkman HP |title=Assessment of gastric emptying and small-bowel motility: scintigraphy, breath tests, manometry, and SmartPill |journal=Gastrointest. Endosc. Clin. N. Am. |volume=19 |issue=1 |pages=49–55, vi |year=2009 |pmid=19232280 |doi=10.1016/j.giec.2008.12.003 |url=}}</ref><ref name="pmid19115465">{{cite journal |vauthors=Waseem S, Moshiree B, Draganov PV |title=Gastroparesis: current diagnostic challenges and management considerations |journal=World J. Gastroenterol. |volume=15 |issue=1 |pages=25–37 |year=2009 |pmid=19115465 |pmc=2653292 |doi= |url=}}</ref><ref name="pmid3699409">{{cite journal |vauthors=Mearin F, Camilleri M, Malagelada JR |title=Pyloric dysfunction in diabetics with recurrent nausea and vomiting |journal=Gastroenterology |volume=90 |issue=6 |pages=1919–25 |year=1986 |pmid=3699409 |doi= |url=}}</ref><ref name="pmid18028513">{{cite journal |vauthors=Abell TL, Camilleri M, Donohoe K, Hasler WL, Lin HC, Maurer AH, McCallum RW, Nowak T, Nusynowitz ML, Parkman HP, Shreve P, Szarka LA, Snape WJ, Ziessman HA |title=Consensus recommendations for gastric emptying scintigraphy: a joint report of the American Neurogastroenterology and Motility Society and the Society of Nuclear Medicine |journal=Am. J. Gastroenterol. |volume=103 |issue=3 |pages=753–63 |year=2008 |pmid=18028513 |doi=10.1111/j.1572-0241.2007.01636.x |url=}}</ref><ref name="pmid12014357">{{cite journal |vauthors=Jiang CF, Ng KW, Tan SW, Wu CS, Chen HC, Liang CT, Chen YH |title=Serum level of amylase and lipase in various stages of chronic renal insufficiency |journal=Zhonghua Yi Xue Za Zhi (Taipei) |volume=65 |issue=2 |pages=49–54 |year=2002 |pmid=12014357 |doi= |url=}}</ref><ref name="SzmuklerYoung1990">{{cite journal|last1=Szmukler|first1=G. I.|last2=Young|first2=G. P.|last3=Lichtenstein|first3=M.|last4=Andrews|first4=J. T.|title=A serial study of gastric emptying in anorexia nervosa and bulimia|journal=Australian and New Zealand Journal of Medicine|volume=20|issue=3|year=1990|pages=220–225|issn=00048291|doi=10.1111/j.1445-5994.1990.tb01023.x}}</ref><ref name="pmid12827003">{{cite journal |vauthors=Diamanti A, Bracci F, Gambarara M, Ciofetta GC, Sabbi T, Ponticelli A, Montecchi F, Marinucci S, Bianco G, Castro M |title=Gastric electric activity assessed by electrogastrography and gastric emptying scintigraphy in adolescents with eating disorders |journal=J. Pediatr. Gastroenterol. Nutr. |volume=37 |issue=1 |pages=35–41 |year=2003 |pmid=12827003 |doi= |url=}}</ref><ref name="pmid981449">{{cite journal |vauthors=Ferholt J, Provence S |title=Diagnosis and treatment of an infant with psychophysiological vomiting |journal=Psychoanal Study Child |volume=31 |issue= |pages=439–59 |year=1976 |pmid=981449 |doi= |url=}}</ref><ref name="pmid17914944">{{cite journal |vauthors=Lee H, Rhee PL, Park EH, Kim JH, Son HJ, Kim JJ, Rhee JC |title=Clinical outcome of rumination syndrome in adults without psychiatric illness: a prospective study |journal=J. Gastroenterol. Hepatol. |volume=22 |issue=11 |pages=1741–7 |year=2007 |pmid=17914944 |doi=10.1111/j.1440-1746.2006.04617.x |url=}}</ref><ref name="pmid9635600">{{cite journal |vauthors=Koskenpato J, Kairemo K, Korppi-Tommola T, Färkkilä M |title=Role of gastric emptying in functional dyspepsia: a scintigraphic study of 94 subjects |journal=Dig. Dis. Sci. |volume=43 |issue=6 |pages=1154–8 |year=1998 |pmid=9635600 |doi= |url=}}</ref><ref name="pmid7658213">{{cite journal |vauthors=Urbain JL, Vekemans MC, Parkman H, Van Cauteren J, Mayeur SM, Van den Maegdenbergh V, Charkes ND, Fisher RS, Malmud LS, De Roo M |title=Dynamic antral scintigraphy to characterize gastric antral motility in functional dyspepsia |journal=J. Nucl. Med. |volume=36 |issue=9 |pages=1579–86 |year=1995 |pmid=7658213 |doi= |url=}}</ref><ref name="pmid20723071">{{cite journal |vauthors=Hejazi RA, Lavenbarg TH, McCallum RW |title=Spectrum of gastric emptying patterns in adult patients with cyclic vomiting syndrome |journal=Neurogastroenterol. Motil. |volume=22 |issue=12 |pages=1298–302, e338 |year=2010 |pmid=20723071 |doi=10.1111/j.1365-2982.2010.01584.x |url=}}</ref><ref name="urlGastric outlet obstruction - an overview | ScienceDirect Topics">{{cite web |url=https://www.sciencedirect.com/topics/veterinary-science-and-veterinary-medicine/gastric-outlet-obstruction |title=Gastric outlet obstruction - an overview &#124; ScienceDirect Topics |format= |work= |accessdate=}}</ref><ref name="pmid6370777">{{cite journal |vauthors=Minami H, McCallum RW |title=The physiology and pathophysiology of gastric emptying in humans |journal=Gastroenterology |volume=86 |issue=6 |pages=1592–610 |year=1984 |pmid=6370777 |doi= |url=}}</ref><ref name="pmid2431640">{{cite journal |vauthors=Humphries LL, Adams LJ, Eckfeldt JH, Levitt MD, McClain CJ |title=Hyperamylasemia in patients with eating disorders |journal=Ann. Intern. Med. |volume=106 |issue=1 |pages=50–2 |year=1987 |pmid=2431640 |doi= |url=}}</ref><ref name="pmid2480214">{{cite journal |vauthors=Hempen I, Lehnert P, Fichter M, Teufel J |title=[Hyperamylasemia in anorexia nervosa and bulimia nervosa. Indication of a pancreatic disease?] |language=German |journal=Dtsch. Med. Wochenschr. |volume=114 |issue=49 |pages=1913–6 |year=1989 |pmid=2480214 |doi=10.1055/s-2008-1066848 |url=}}</ref><ref name="pmid19204432">{{cite journal |vauthors=Okada R, Okada A, Okada T, Okada T, Hamajima N |title=Elevated serum lipase levels in patients with dyspepsia of unknown cause in general practice |journal=Med Princ Pract |volume=18 |issue=2 |pages=130–6 |year=2009 |pmid=19204432 |doi=10.1159/000189811 |url=}}</ref><ref name="pmid23198276">{{cite journal |vauthors=Sansone RA, Sansone LA |title=Hoarseness: a sign of self-induced vomiting? |journal=Innov Clin Neurosci |volume=9 |issue=10 |pages=37–41 |year=2012 |pmid=23198276 |pmc=3508961 |doi= |url=}}</ref><ref name="pmid15972301">{{cite journal |vauthors=Tack J, Caenepeel P, Arts J, Lee KJ, Sifrim D, Janssens J |title=Prevalence of acid reflux in functional dyspepsia and its association with symptom profile |journal=Gut |volume=54 |issue=10 |pages=1370–6 |year=2005 |pmid=15972301 |pmc=1774686 |doi=10.1136/gut.2004.053355 |url=}}</ref><ref name="urlgut.bmj.com">{{cite web |url=http://gut.bmj.com/content/gutjnl/early/2005/06/21/gut.2004.053355.full.pdf |title=gut.bmj.com |format= |work= |accessdate=}}</ref><ref name="pmid10490048">{{cite journal |vauthors=Boles RG, Williams JC |title=Mitochondrial disease and cyclic vomiting syndrome |journal=Dig. Dis. Sci. |volume=44 |issue=8 Suppl |pages=103S–107S |year=1999 |pmid=10490048 |doi= |url=}}</ref><ref name="pmid24112485">{{cite journal |vauthors=Ranasinghe WK, Smith M |title=Gastric outlet obstruction with an elevated serum pancreatic lipase secondary to an infraumbilical hernia |journal=Ann R Coll Surg Engl |volume=95 |issue=7 |pages=122–4 |year=2013 |pmid=24112485 |doi=10.1308/003588413X13629960047795 |url=}}</ref><ref name="UiShibusawa2015">{{cite journal|last1=Ui|first1=Takashi|last2=Shibusawa|first2=Hiroyuki|last3=Tsukui|first3=Hidenori|last4=Sakuma|first4=Kazuya|last5=Takahashi|first5=Shuhei|last6=Lefor|first6=Alan K.|last7=Hosoya|first7=Yoshinori|last8=Sata|first8=Naohiro|last9=Yasuda|first9=Yoshikazu|title=Pretreatment of gastric outlet obstruction with pancrelipase: Report of a case|journal=International Journal of Surgery Case Reports|volume=12|year=2015|pages=87–89|issn=22102612|doi=10.1016/j.ijscr.2015.05.023}}</ref>
Rumination syndrome should be differentiated from other diseases that cause chronic [[nausea and vomiting]]. The differentials include the following:<ref name="pmid25667023">{{cite journal |vauthors=Parkman HP |title=Idiopathic gastroparesis |journal=Gastroenterol. Clin. North Am. |volume=44 |issue=1 |pages=59–68 |year=2015 |pmid=25667023 |pmc=4324534 |doi=10.1016/j.gtc.2014.11.015 |url=}}</ref><ref name="pmid17015559">{{cite journal |vauthors=Werlin SL, Fish DL |title=The spectrum of valproic acid-associated pancreatitis |journal=Pediatrics |volume=118 |issue=4 |pages=1660–3 |year=2006 |pmid=17015559 |doi=10.1542/peds.2006-1182 |url=}}</ref><ref name="pmid16369243">{{cite journal |vauthors=Noddin L, Callahan M, Lacy BE |title=Irritable bowel syndrome and functional dyspepsia: different diseases or a single disorder with different manifestations? |journal=MedGenMed |volume=7 |issue=3 |pages=17 |year=2005 |pmid=16369243 |pmc=1681633 |doi= |url=}}</ref><ref name="pmid23226859">{{cite journal |vauthors=Gupta R, Kalla M, Gupta JB |title=Adult rumination syndrome: Differentiation from psychogenic intractable vomiting |journal=Indian J Psychiatry |volume=54 |issue=3 |pages=283–5 |year=2012 |pmid=23226859 |pmc=3512372 |doi=10.4103/0019-5545.102434 |url=}}</ref><ref name="urlBody weight in bulimia nervosa | SpringerLink">{{cite web |url=https://link.springer.com/article/10.1007/BF03339730 |title=Body weight in bulimia nervosa &#124; SpringerLink |format= |work= |accessdate=}}</ref><ref name="pmid25904280">{{cite journal |vauthors=Sağlam F, Sivrikoz E, Alemdar A, Kamalı S, Arslan U, Güven H |title=Bouveret syndrome: A fatal diagnostic dilemma of gastric outlet obstruction |journal=Ulus Travma Acil Cerrahi Derg |volume=21 |issue=2 |pages=157–9 |year=2015 |pmid=25904280 |doi= |url=}}</ref><ref name="pmid21475419">{{cite journal |vauthors=Talley NJ |title=Rumination syndrome |journal=Gastroenterol Hepatol (N Y) |volume=7 |issue=2 |pages=117–8 |year=2011 |pmid=21475419 |pmc=3061016 |doi= |url=}}</ref><ref name="pmid15067630">{{cite journal |vauthors=Tutuian R, Castell DO |title=Rumination documented by using combined multichannel intraluminal impedance and manometry |journal=Clin. Gastroenterol. Hepatol. |volume=2 |issue=4 |pages=340–3 |year=2004 |pmid=15067630 |doi= |url=}}</ref><ref name="pmid24921208">{{cite journal |vauthors=Kessing BF, Smout AJ, Bredenoord AJ |title=Current diagnosis and management of the rumination syndrome |journal=J. Clin. Gastroenterol. |volume=48 |issue=6 |pages=478–83 |year=2014 |pmid=24921208 |doi=10.1097/MCG.0000000000000142 |url=}}</ref><ref name="pmid19232280">{{cite journal |vauthors=Parkman HP |title=Assessment of gastric emptying and small-bowel motility: scintigraphy, breath tests, manometry, and SmartPill |journal=Gastrointest. Endosc. Clin. N. Am. |volume=19 |issue=1 |pages=49–55, vi |year=2009 |pmid=19232280 |doi=10.1016/j.giec.2008.12.003 |url=}}</ref><ref name="pmid19115465">{{cite journal |vauthors=Waseem S, Moshiree B, Draganov PV |title=Gastroparesis: current diagnostic challenges and management considerations |journal=World J. Gastroenterol. |volume=15 |issue=1 |pages=25–37 |year=2009 |pmid=19115465 |pmc=2653292 |doi= |url=}}</ref><ref name="pmid3699409">{{cite journal |vauthors=Mearin F, Camilleri M, Malagelada JR |title=Pyloric dysfunction in diabetics with recurrent nausea and vomiting |journal=Gastroenterology |volume=90 |issue=6 |pages=1919–25 |year=1986 |pmid=3699409 |doi= |url=}}</ref><ref name="pmid18028513">{{cite journal |vauthors=Abell TL, Camilleri M, Donohoe K, Hasler WL, Lin HC, Maurer AH, McCallum RW, Nowak T, Nusynowitz ML, Parkman HP, Shreve P, Szarka LA, Snape WJ, Ziessman HA |title=Consensus recommendations for gastric emptying scintigraphy: a joint report of the American Neurogastroenterology and Motility Society and the Society of Nuclear Medicine |journal=Am. J. Gastroenterol. |volume=103 |issue=3 |pages=753–63 |year=2008 |pmid=18028513 |doi=10.1111/j.1572-0241.2007.01636.x |url=}}</ref><ref name="pmid12014357">{{cite journal |vauthors=Jiang CF, Ng KW, Tan SW, Wu CS, Chen HC, Liang CT, Chen YH |title=Serum level of amylase and lipase in various stages of chronic renal insufficiency |journal=Zhonghua Yi Xue Za Zhi (Taipei) |volume=65 |issue=2 |pages=49–54 |year=2002 |pmid=12014357 |doi= |url=}}</ref><ref name="SzmuklerYoung1990">{{cite journal|last1=Szmukler|first1=G. I.|last2=Young|first2=G. P.|last3=Lichtenstein|first3=M.|last4=Andrews|first4=J. T.|title=A serial study of gastric emptying in anorexia nervosa and bulimia|journal=Australian and New Zealand Journal of Medicine|volume=20|issue=3|year=1990|pages=220–225|issn=00048291|doi=10.1111/j.1445-5994.1990.tb01023.x}}</ref><ref name="pmid12827003">{{cite journal |vauthors=Diamanti A, Bracci F, Gambarara M, Ciofetta GC, Sabbi T, Ponticelli A, Montecchi F, Marinucci S, Bianco G, Castro M |title=Gastric electric activity assessed by electrogastrography and gastric emptying scintigraphy in adolescents with eating disorders |journal=J. Pediatr. Gastroenterol. Nutr. |volume=37 |issue=1 |pages=35–41 |year=2003 |pmid=12827003 |doi= |url=}}</ref><ref name="pmid981449">{{cite journal |vauthors=Ferholt J, Provence S |title=Diagnosis and treatment of an infant with psychophysiological vomiting |journal=Psychoanal Study Child |volume=31 |issue= |pages=439–59 |year=1976 |pmid=981449 |doi= |url=}}</ref><ref name="pmid17914944">{{cite journal |vauthors=Lee H, Rhee PL, Park EH, Kim JH, Son HJ, Kim JJ, Rhee JC |title=Clinical outcome of rumination syndrome in adults without psychiatric illness: a prospective study |journal=J. Gastroenterol. Hepatol. |volume=22 |issue=11 |pages=1741–7 |year=2007 |pmid=17914944 |doi=10.1111/j.1440-1746.2006.04617.x |url=}}</ref><ref name="pmid9635600">{{cite journal |vauthors=Koskenpato J, Kairemo K, Korppi-Tommola T, Färkkilä M |title=Role of gastric emptying in functional dyspepsia: a scintigraphic study of 94 subjects |journal=Dig. Dis. Sci. |volume=43 |issue=6 |pages=1154–8 |year=1998 |pmid=9635600 |doi= |url=}}</ref><ref name="pmid7658213">{{cite journal |vauthors=Urbain JL, Vekemans MC, Parkman H, Van Cauteren J, Mayeur SM, Van den Maegdenbergh V, Charkes ND, Fisher RS, Malmud LS, De Roo M |title=Dynamic antral scintigraphy to characterize gastric antral motility in functional dyspepsia |journal=J. Nucl. Med. |volume=36 |issue=9 |pages=1579–86 |year=1995 |pmid=7658213 |doi= |url=}}</ref><ref name="pmid20723071">{{cite journal |vauthors=Hejazi RA, Lavenbarg TH, McCallum RW |title=Spectrum of gastric emptying patterns in adult patients with cyclic vomiting syndrome |journal=Neurogastroenterol. Motil. |volume=22 |issue=12 |pages=1298–302, e338 |year=2010 |pmid=20723071 |doi=10.1111/j.1365-2982.2010.01584.x |url=}}</ref><ref name="urlGastric outlet obstruction - an overview | ScienceDirect Topics">{{cite web |url=https://www.sciencedirect.com/topics/veterinary-science-and-veterinary-medicine/gastric-outlet-obstruction |title=Gastric outlet obstruction - an overview &#124; ScienceDirect Topics |format= |work= |accessdate=}}</ref><ref name="pmid6370777">{{cite journal |vauthors=Minami H, McCallum RW |title=The physiology and pathophysiology of gastric emptying in humans |journal=Gastroenterology |volume=86 |issue=6 |pages=1592–610 |year=1984 |pmid=6370777 |doi= |url=}}</ref><ref name="pmid2431640">{{cite journal |vauthors=Humphries LL, Adams LJ, Eckfeldt JH, Levitt MD, McClain CJ |title=Hyperamylasemia in patients with eating disorders |journal=Ann. Intern. Med. |volume=106 |issue=1 |pages=50–2 |year=1987 |pmid=2431640 |doi= |url=}}</ref><ref name="pmid2480214">{{cite journal |vauthors=Hempen I, Lehnert P, Fichter M, Teufel J |title=[Hyperamylasemia in anorexia nervosa and bulimia nervosa. Indication of a pancreatic disease?] |language=German |journal=Dtsch. Med. Wochenschr. |volume=114 |issue=49 |pages=1913–6 |year=1989 |pmid=2480214 |doi=10.1055/s-2008-1066848 |url=}}</ref><ref name="pmid19204432">{{cite journal |vauthors=Okada R, Okada A, Okada T, Okada T, Hamajima N |title=Elevated serum lipase levels in patients with dyspepsia of unknown cause in general practice |journal=Med Princ Pract |volume=18 |issue=2 |pages=130–6 |year=2009 |pmid=19204432 |doi=10.1159/000189811 |url=}}</ref><ref name="pmid23198276">{{cite journal |vauthors=Sansone RA, Sansone LA |title=Hoarseness: a sign of self-induced vomiting? |journal=Innov Clin Neurosci |volume=9 |issue=10 |pages=37–41 |year=2012 |pmid=23198276 |pmc=3508961 |doi= |url=}}</ref><ref name="pmid15972301">{{cite journal |vauthors=Tack J, Caenepeel P, Arts J, Lee KJ, Sifrim D, Janssens J |title=Prevalence of acid reflux in functional dyspepsia and its association with symptom profile |journal=Gut |volume=54 |issue=10 |pages=1370–6 |year=2005 |pmid=15972301 |pmc=1774686 |doi=10.1136/gut.2004.053355 |url=}}</ref><ref name="urlgut.bmj.com">{{cite web |url=http://gut.bmj.com/content/gutjnl/early/2005/06/21/gut.2004.053355.full.pdf |title=gut.bmj.com |format= |work= |accessdate=}}</ref><ref name="pmid10490048">{{cite journal |vauthors=Boles RG, Williams JC |title=Mitochondrial disease and cyclic vomiting syndrome |journal=Dig. Dis. Sci. |volume=44 |issue=8 Suppl |pages=103S–107S |year=1999 |pmid=10490048 |doi= |url=}}</ref><ref name="pmid24112485">{{cite journal |vauthors=Ranasinghe WK, Smith M |title=Gastric outlet obstruction with an elevated serum pancreatic lipase secondary to an infraumbilical hernia |journal=Ann R Coll Surg Engl |volume=95 |issue=7 |pages=122–4 |year=2013 |pmid=24112485 |doi=10.1308/003588413X13629960047795 |url=}}</ref><ref name="UiShibusawa2015">{{cite journal|last1=Ui|first1=Takashi|last2=Shibusawa|first2=Hiroyuki|last3=Tsukui|first3=Hidenori|last4=Sakuma|first4=Kazuya|last5=Takahashi|first5=Shuhei|last6=Lefor|first6=Alan K.|last7=Hosoya|first7=Yoshinori|last8=Sata|first8=Naohiro|last9=Yasuda|first9=Yoshikazu|title=Pretreatment of gastric outlet obstruction with pancrelipase: Report of a case|journal=International Journal of Surgery Case Reports|volume=12|year=2015|pages=87–89|issn=22102612|doi=10.1016/j.ijscr.2015.05.023}}</ref>
==[[ Rumination disorder Diagnosis and Evaluation]]==
The Rome IV diagnostic criteria for rumination syndrome are as follows. The following requirements must be satisfied in order for the Rome IV criteria to be satisfied: both adults and kids
●Repeatedly or persistently vomiting previously consumed food into the mouth, followed by swallowing, spitting, or remastication
●Retching does not occur before regurgitation
Additional clinical characteristics that are helpful in supporting the diagnosis of rumination syndrome but are not necessary include:
Rumination stops when the regurgitated material turns acidic. ●Effortless regurgitation episodes often do not include nausea. ●Regurgitant contains identifiable food that may taste good.
The diagnostic criteria for rumination in children are identical, with the exception that it cannot happen when the kid is sleeping or react to conventional reflux medication.
Assessment
History and physical examination: The goal of the history should be to determine if the postprandial symptoms are regurgitation or vomiting, as this is what patients frequently describe. Unlike vomiting, regurgitation is painless, doesn't always cause nausea, and doesn't include heaving or retching beforehand. In people with rumination syndrome, vomiting is not something that can be willingly held in the mouth or re-ingested, in contrast to regurgitate. Before the beginning of rumination symptoms, patients with rumination syndrome frequently recall a triggering event.<ref name="PMID:27144632">{{cite journal |vauthors=Hyams JS|title= Functional Disorders: Children and Adolescents. Gastroenterology.    |PMID= 27144632.|url=}}</ref>
Based on their medical history, children and adolescents who exhibit symptoms suggestive of rumination syndrome should have eating disorders ruled out.
Rule out mechanical obstruction: Using upper gastrointestinal endoscopy and, if in doubt, CT/MR enterography, we rule out mechanical obstruction in patients who are suspected of having rumination syndrome.
Rule out mechanical obstruction: Using upper gastrointestinal endoscopy and, if in doubt, CT/MR enterography, we rule out mechanical obstruction in patients who are suspected of having rumination syndrome. In most cases, upper endoscopy results for rumination syndrome patients are normal. Patients may occasionally show signs of esophagitis. To rule out other conditions, such as H. pylori infection, celiac disease, and eosinophilic gastroenteritis, we do biopsies.
High resolution impedance pH manometry: Reflux episodes that extend to the proximal esophagus and are strongly linked to an increase in stomach pressure to >30 mm Hg are diagnostic findings of rumination syndrome on postprandial high resolution impedance manometry.<ref name="PMID:24366235">{{cite journal |vauthors=Kessing BF |title= Objective manometric criteria for the rumination syndrome.    |PMID= 24366235.|url=}}</ref> There are no defined normative norms for traditional manometry.
Based on the high resolution manometry pressure pattern, three rumination variations may be identified:
●First rumination: Retrograde flow occurs before a rise in abdominal pressure.
▏Secondary rumination: When a reflux event starts, there's an instant rise in abdominal pressure. ●Supragastric belch-induced rumination: When a supragastric belch occurs, it's immediately followed by a ruminating episode.
Rumination tendencies in children seem to be comparable to those in adults, despite the paucity of research in this area. A diagnostic threshold for retrograde bolus flow into the proximal esophagus, linked to a stomach pressure rise of more than 25 mmHg, has been suggested as the threshold for rumination syndrome in children.
<ref name="PMID:28078818">{{cite journal |vauthors=Singendonk MMJ |title= Objectively diagnosing rumination syndrome in children using esophageal pH-impedance and manometry. Neurogastroenterol Motil  |PMID= 28078818.|url=}}</ref> <ref name="PMID:38385686.">{{cite journal |vauthors=Puoti MG |title= he role of high-resolution impedance manometry to identify rumination syndrome in children with unexplained foregut symptoms. Neurogastroenterol Motil  |PMID= 38385686.|url=}}</ref>
==[[ Rumination disorder Management]]==
first-hand supervision
Education and treatment of linked mood disorders: Reassurance and education are crucial parts of the first steps in managing rumination syndrome. Enhancing the patient's comprehension of their illness and motivating them to actively participate in their care are the two main goals of education. Gastroenterologists and psychologists must work together in a multidisciplinary manner, particularly when treating patients who have underlying anxiety disorders, depression, or refractory symptoms.
Diaphragmatic (abdominal) breathing: This technique is the cornerstone of treatment for rumination syndrome (figure 2). The gastroesophageal pressure gradient is restored by diaphragmatic breathing, which lowers postprandial intragastric pressure and raises esophagogastric junction zone pressure. By using this method, patients stretch their abdomen and compress their diaphragm to inhale. <ref name="PMID:20763087.">{{cite journal |vauthors=Brockbank EM |title=  MERYCISM OR RUMINATION IN MAN. Neurogastroenterol Motil|PMID= 20763087.|url=}}</ref>
Refractory signs and symptoms
Gamma-aminobutyric acid receptor agonist: Baclofen is only used in people whose symptoms don't respond to first-line treatment. A gamma-aminobutyric acid agonist called Baclofen increases the tone of the lower esophageal sphincter and inhibits brief relaxations of it. The effect of baclofen on regurgitation in rumination syndrome has only been assessed in two trials. For a week, baclofen (10 mg three times daily) was administered to sixteen adult patients with clinically suspected rumination syndrome as part of an open-label experiment. Treatment with baclofen was linked to a substantial decrease in the frequency of postprandial flow episodes and symptoms in 12 individuals who finished the research as compared to baseline.<ref name="PMID:22079512.">{{cite journal |vauthors=Blondeau K |title=  Baclofen improves symptoms and reduces postprandial flow events in patients with rumination and supragastric belching. Neurogastroenterol Motil  |PMID= 22079512.|url=}}</ref>. However, long-term data on efficacy and tolerability are lacking. Baclofen crosses the blood-brain barrier and causes a variety of central nervous system-related side effects. Side-effects primarily include somnolence, confusion, dizziness, lightheadedness, drowsiness, weakness, and trembling. We usually begin by giving 5 to 10 mg at bedtime, which can be increased slowly to 10 mg three times daily while carefully monitoring for side effects.


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{{CMG} ; Associate Editor(s)-in-Chief: Mark Warren, M.D., M.P.H.; Fellow, Academy of Eating Disorders [1];Rithish Nimmagadda,MBBS.[2]; Kiran Singh, M.D. [3]

Synonyms and keywords: Childhood rumination disorder; merycism, rumination syndrome

Overview

Rumination is an eating disorder characterized by having the contents of the stomach drawn back up into the mouth, chewed for a second time, and swallowed again. In some animals, known as ruminants, this is a natural and healthy part of digestion and is not considered an eating disorder. However, in other species (including humans), such behavior is atypical and potentially dangerous as the esophagus can be damaged by frequent exposure to stomach acids. Rumination is also associated with eating disorders such as anorexia nervosa, and can be the result of one's apprehension and nervousness after eating a normal meal. For those with purging behaviors, rumination can take place when the option of getting rid of a meal via throwing up is not available (thus, one might feel worried and visibly upset). Rumination has also been reported in developmentally normal children and adults who experience regurgitation of previously swallowed food, without disgust, nausea or an acidic taste. The food is either chewed and reswallowed or spat out. Remission of these episodes is seen in some cases while others persist. Many claim this as a pleasurable habit.


Historical Perspective , Epidemiology and Demographics

prevalence: Both adults and children are susceptible to rumination syndrome. Out of the 2163 children and adolescents questioned for this study, 110 (5%) met the clinical criteria for rumination syndrome. In one research conducted in the United States, the prevalence of rumination was 5.8 percent [1]

in another, almost 50,000 individuals were questioned in 26 nations. Rumination syndrome may affect as many as 7 to 8 percent of people with fibromyalgia or eating problems.[2] Related disorders
Constipation from a rectal evacuation disorder, anxiety, depression, adjustment disorder, obsessive compulsive disorder, post-traumatic stress disorder, and attention deficit-hyperactivity disorder have all been linked to rumination syndrome. While some research indicates that adults and adolescents with developmental delays are more likely to experience rumination syndrome


Pathophysiology

Although the exact cause of rumination syndrome is unknown, one important pathogenetic characteristic that seems to be present is unperceived abdominal wall activity throughout the postprandial interval. Although the precise cause of this activation of the abdominal wall is unknown, given the similarities between rumination syndrome and functional dyspepsia, it is plausible that postprandial dyspeptic symptoms are the trigger for rumination episodes.[3]

In individuals with rumination syndrome, a permissive esophagogastric gradient is created by a combination of elevated intra-abdominal pressure and negative intrathoracic pressure, which causes the retrograde flow of eaten gastric material into the mouth. Rumination occurs after stomach pressurizations surpassing 30 mmHg on postprandial esophageal high resolution impedance manometry. This is linked to lower and upper esophageal relaxation during the gastric pressurization. This suggests that malfunctioning of the upper and lower esophageal sphincters is probably involved in rumination and that elevated intra-abdominal pressure alone is not sufficient to explain it.[4]

It is believed that the activation of the muscles in the abdominal wall is what causes this surge in intraluminal pressure. During electromyography recordings, postprandial abdominal wall activity has also been noted; this activation is correlated with bouts of regurgitation. [5] [6]


Clinical features

The hallmark of rumination syndrome is fast regurgitation, typically starting within ten minutes of meal completion. Episodes often last for one to two hours following the meal, and the regurgitant is made up of partly digested food that tastes similar to what was really swallowed. Easy to perform, regurgitation is frequently caused by an abdominal ache, pressure, or burning feeling that has to be eased.

Retching is not typically seen before an episode. Consciously, the content is regurgitated or reabsorbed. Regurgitation happens usually, if not always, after eating. In order to make up for this, patients frequently modify their eating habits and may stop eating in public.

Patients often express nausea and dyspepsia symptoms such as burning or fullness in the stomach, and there is almost a four-fold increased likelihood of overlap between rumination syndrome and functional dyspepsia than would be predicted by chance. It is unusual to have overt discomfort. About 20 to 40 percent of patients have shown signs of weight reduction. In the absence of a co-occurring eating problem, significant weight loss, electrolyte imbalances, tooth erosions, and malnutrition are uncommon. [7] [4] [8]

Differentiating Rumination disorderfrom other Diseases

Rumination syndrome should be differentiated from other diseases that cause chronic nausea and vomiting. The differentials include the following:[9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40]



Rumination disorder Diagnosis and Evaluation

The Rome IV diagnostic criteria for rumination syndrome are as follows. The following requirements must be satisfied in order for the Rome IV criteria to be satisfied: both adults and kids

●Repeatedly or persistently vomiting previously consumed food into the mouth, followed by swallowing, spitting, or remastication ●Retching does not occur before regurgitation Additional clinical characteristics that are helpful in supporting the diagnosis of rumination syndrome but are not necessary include:

Rumination stops when the regurgitated material turns acidic. ●Effortless regurgitation episodes often do not include nausea. ●Regurgitant contains identifiable food that may taste good. The diagnostic criteria for rumination in children are identical, with the exception that it cannot happen when the kid is sleeping or react to conventional reflux medication.

Assessment

History and physical examination: The goal of the history should be to determine if the postprandial symptoms are regurgitation or vomiting, as this is what patients frequently describe. Unlike vomiting, regurgitation is painless, doesn't always cause nausea, and doesn't include heaving or retching beforehand. In people with rumination syndrome, vomiting is not something that can be willingly held in the mouth or re-ingested, in contrast to regurgitate. Before the beginning of rumination symptoms, patients with rumination syndrome frequently recall a triggering event.[41]

Based on their medical history, children and adolescents who exhibit symptoms suggestive of rumination syndrome should have eating disorders ruled out. Rule out mechanical obstruction: Using upper gastrointestinal endoscopy and, if in doubt, CT/MR enterography, we rule out mechanical obstruction in patients who are suspected of having rumination syndrome.

Rule out mechanical obstruction: Using upper gastrointestinal endoscopy and, if in doubt, CT/MR enterography, we rule out mechanical obstruction in patients who are suspected of having rumination syndrome. In most cases, upper endoscopy results for rumination syndrome patients are normal. Patients may occasionally show signs of esophagitis. To rule out other conditions, such as H. pylori infection, celiac disease, and eosinophilic gastroenteritis, we do biopsies.

High resolution impedance pH manometry: Reflux episodes that extend to the proximal esophagus and are strongly linked to an increase in stomach pressure to >30 mm Hg are diagnostic findings of rumination syndrome on postprandial high resolution impedance manometry.[42] There are no defined normative norms for traditional manometry.

Based on the high resolution manometry pressure pattern, three rumination variations may be identified:

●First rumination: Retrograde flow occurs before a rise in abdominal pressure. ▏Secondary rumination: When a reflux event starts, there's an instant rise in abdominal pressure. ●Supragastric belch-induced rumination: When a supragastric belch occurs, it's immediately followed by a ruminating episode. Rumination tendencies in children seem to be comparable to those in adults, despite the paucity of research in this area. A diagnostic threshold for retrograde bolus flow into the proximal esophagus, linked to a stomach pressure rise of more than 25 mmHg, has been suggested as the threshold for rumination syndrome in children. [43] [44]


Rumination disorder Management

first-hand supervision

Education and treatment of linked mood disorders: Reassurance and education are crucial parts of the first steps in managing rumination syndrome. Enhancing the patient's comprehension of their illness and motivating them to actively participate in their care are the two main goals of education. Gastroenterologists and psychologists must work together in a multidisciplinary manner, particularly when treating patients who have underlying anxiety disorders, depression, or refractory symptoms.

Diaphragmatic (abdominal) breathing: This technique is the cornerstone of treatment for rumination syndrome (figure 2). The gastroesophageal pressure gradient is restored by diaphragmatic breathing, which lowers postprandial intragastric pressure and raises esophagogastric junction zone pressure. By using this method, patients stretch their abdomen and compress their diaphragm to inhale. [45]

Refractory signs and symptoms

Gamma-aminobutyric acid receptor agonist: Baclofen is only used in people whose symptoms don't respond to first-line treatment. A gamma-aminobutyric acid agonist called Baclofen increases the tone of the lower esophageal sphincter and inhibits brief relaxations of it. The effect of baclofen on regurgitation in rumination syndrome has only been assessed in two trials. For a week, baclofen (10 mg three times daily) was administered to sixteen adult patients with clinically suspected rumination syndrome as part of an open-label experiment. Treatment with baclofen was linked to a substantial decrease in the frequency of postprandial flow episodes and symptoms in 12 individuals who finished the research as compared to baseline.[46]. However, long-term data on efficacy and tolerability are lacking. Baclofen crosses the blood-brain barrier and causes a variety of central nervous system-related side effects. Side-effects primarily include somnolence, confusion, dizziness, lightheadedness, drowsiness, weakness, and trembling. We usually begin by giving 5 to 10 mg at bedtime, which can be increased slowly to 10 mg three times daily while carefully monitoring for side effects.



Disorder Clinical features Laboratory findings
Chronic nausea Vomiting Diarrhea Retching Lethargy Social withdrawal Photophobia Epigastric pain/burning Lanugo hair Hypogonadism Russel's sign Body mass index (normal range: 18.5 to 24.9) Complete blood count (CBC) Electrolyte imabalance Lipase and amylase levels Gastric scintigraphy Ambulatory esophageal pH and impedance testing
Gastroparesis ✔ ✔ (within 1 hour of eating) - ✔ ✔ - - ✔ - - - ↓ ✔
  • Normal (maybe elevated if chronic renal failure is the cause of gastroparesis- usually less than threefold)
  • Periodic measurement of radiolabeled solid meal:  
    • Grade 1 (mild), 11%-20% retention at 4 h
    • Grade 2 (moderate), 21%-35% retention at 4 h
    • Grade 3 (severe), 36%-50% retention at 4 h
    • Grade 4 (very severe), > 50% retention at 4 h
  • Impedance testing (antroduodenal manometery): Loss of normal fasting migratory motor complexes (MMCs) and reduced postprandial antral contractions and, in some cases pylorospasm
Anorexia nervosa ✔ ✔ ✔ - ✔ ✔ - - ✔ ✔ - ↓ ✔
  • Increased
Bulimia nervosa ✔ ✔ ✔ ✔ ✔ ✔ - - - ✔ ✔ Normal ✔
  • Increased
Rumination syndrome ✔ ✔ (Regurgitation more common- within minutes of meal intake) ✔ - ✔ ✔ ✔ ✔ - - - ↓
  • Normal
 ✔
  • Normal
  • Esophageal pH: Fall in esophageal pH immediately after reguritation (occurs while patient is awake and erect; this is in contrast to GERD, where reflux occurs diurnally and supine position)
Functional dyspepsia ✔ ✔ ✔ ✔ - - - - - - - Normal
  • Normal
 ✔
  • Esophageal pH: May be decreased if patient develops reflux
Cyclic vomiting syndrome ✔ ✔ - ✔ ✔ - - - - - - ↓ ✔
  • Rapid or normal
  • Esophageal pH: Decreased
Pancreatitis ✔ ✔ ✔ ✔ ✔ - - ✔ - - - Normal ✔
  • Increased
  • Not indicated
  • Esophageal pH: Normal
Gastric outlet obstruction ✔ ✔ (within 1 hour of eating) - - - - - ✔ - - - ↓ ✔
  • Esophageal pH: Increased
  • Esophageal manometery:   High manoraetric score

Other differntials

Other differentials of rumination disorder include the following:

Epidemiology and Demographics

Prevalence

Risk Factors

  • Lack of stimulation
  • Neglect
  • Problems in the parent-child relationship
  • Stressful life situations[47]

Natural History, Complications and Prognosis

Rumination disorder typically occurs within the first 3-12 months of age and can lead to the child becoming malnourished.

While rumination disorder may begin in childhood or infancy, adults may also have this chronic disorder, for which there is presently no known cure nor cause. While those diagnosed with this condition in childhood may 'grow out of it', it is by no means a medical fact that they are bound to do so by adolescence or adulthood.

Remission of these episodes is seen in some cases while others persist.

Diagnostic Criteria

DSM-V Diagnostic Criteria for Rumination Disorder[47]

“
  • A. Repeated regurgitation of food over a period of at least 1 month. Regurgitated food may be re-chewed, re-swallowed, or spit out.

AND

AND

  • C. The eating disturbance does not occur exclusively during the course of anorexia nervosa,bulimia nervosa, binge-eating disorder, or avoidant/restrictive food intake disorder.

AND

D. If the symptoms occur in the context of another mental disorder (e.g., intellectual disability, Intellectual developmental disorder or another neuro developmental disorder),they are sufficiently severe to warrant additional clinical attention.

Specify if:

  • In remission: After full criteria for rumination disorder were previously met, the criteria have not been met for a sustained period of time.
 ”

References

  1. ↑ Josefsson A. "Global Prevalence and Impact of Rumination Syndrome Eur J Brain Pathol. Neurology". PMID 34774539. Check |pmid= value (help).
  2. ↑ Almansa C. "Prevalence of functional gastrointestinal disorders in patients with fibromyalgia and the role of psychologic distress Eur J Brain Pathol. Neurology". PMID 19138763. Check |pmid= value (help).
  3. ↑ Zand Irani M. "Prevalence, symptoms and risk factor profile of rumination syndrome and functional dyspepsia: a population-based study Eur J Brain Pathol. Neurology". PMID 34626489. Check |pmid= value (help).
  4. ↑ 4.0 4.1 Halland M. "Diaphragmatic breathing for rumination syndrome: efficacy and mechanisms of action. Neurogastroenterol Motil Eur J Brain Pathol. Neurology". PMID 26661735. Check |pmid= value (help).
  5. ↑ Barba E. "Randomized, Placebo-Controlled Trial of Biofeedback for the Treatment of Rumination Eur J Brain Pathol. Neurology". PMID 27185077. Check |pmid= value (help).
  6. ↑ Barba E. "Biofeedback-guided control of abdominothoracic muscular activity reduces regurgitation episodes in patients with rumination". PMID 24768808.
  7. ↑ Barba E. "Randomized, Placebo-Controlled Trial of Biofeedback for the Treatment of Rumination". PMID 27185077. Check |pmid= value (help).
  8. ↑ Tucker E. "Rumination variations: aetiology and classification of abnormal behavioural responses to digestive symptoms based on high-resolution manometry studies". PMID 23173868. Check |pmid= value (help).
  9. ↑ Parkman HP (2015). "Idiopathic gastroparesis". Gastroenterol. Clin. North Am. 44 (1): 59–68. doi:10.1016/j.gtc.2014.11.015. PMC 4324534. PMID 25667023.
  10. ↑ Werlin SL, Fish DL (2006). "The spectrum of valproic acid-associated pancreatitis". Pediatrics. 118 (4): 1660–3. doi:10.1542/peds.2006-1182. PMID 17015559.
  11. ↑ Noddin L, Callahan M, Lacy BE (2005). "Irritable bowel syndrome and functional dyspepsia: different diseases or a single disorder with different manifestations?". MedGenMed. 7 (3): 17. PMC 1681633. PMID 16369243.
  12. ↑ Gupta R, Kalla M, Gupta JB (2012). "Adult rumination syndrome: Differentiation from psychogenic intractable vomiting". Indian J Psychiatry. 54 (3): 283–5. doi:10.4103/0019-5545.102434. PMC 3512372. PMID 23226859.
  13. ↑ Sağlam F, Sivrikoz E, Alemdar A, Kamalı S, Arslan U, Güven H (2015). "Bouveret syndrome: A fatal diagnostic dilemma of gastric outlet obstruction". Ulus Travma Acil Cerrahi Derg. 21 (2): 157–9. PMID 25904280.
  14. ↑ Talley NJ (2011). "Rumination syndrome". Gastroenterol Hepatol (N Y). 7 (2): 117–8. PMC 3061016. PMID 21475419.
  15. ↑ Tutuian R, Castell DO (2004). "Rumination documented by using combined multichannel intraluminal impedance and manometry". Clin. Gastroenterol. Hepatol. 2 (4): 340–3. PMID 15067630.
  16. ↑ Kessing BF, Smout AJ, Bredenoord AJ (2014). "Current diagnosis and management of the rumination syndrome". J. Clin. Gastroenterol. 48 (6): 478–83. doi:10.1097/MCG.0000000000000142. PMID 24921208.
  17. ↑ Parkman HP (2009). "Assessment of gastric emptying and small-bowel motility: scintigraphy, breath tests, manometry, and SmartPill". Gastrointest. Endosc. Clin. N. Am. 19 (1): 49–55, vi. doi:10.1016/j.giec.2008.12.003. PMID 19232280.
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  23. ↑ Diamanti A, Bracci F, Gambarara M, Ciofetta GC, Sabbi T, Ponticelli A, Montecchi F, Marinucci S, Bianco G, Castro M (2003). "Gastric electric activity assessed by electrogastrography and gastric emptying scintigraphy in adolescents with eating disorders". J. Pediatr. Gastroenterol. Nutr. 37 (1): 35–41. PMID 12827003.
  24. ↑ Ferholt J, Provence S (1976). "Diagnosis and treatment of an infant with psychophysiological vomiting". Psychoanal Study Child. 31: 439–59. PMID 981449.
  25. ↑ Lee H, Rhee PL, Park EH, Kim JH, Son HJ, Kim JJ, Rhee JC (2007). "Clinical outcome of rumination syndrome in adults without psychiatric illness: a prospective study". J. Gastroenterol. Hepatol. 22 (11): 1741–7. doi:10.1111/j.1440-1746.2006.04617.x. PMID 17914944.
  26. ↑ Koskenpato J, Kairemo K, Korppi-Tommola T, Färkkilä M (1998). "Role of gastric emptying in functional dyspepsia: a scintigraphic study of 94 subjects". Dig. Dis. Sci. 43 (6): 1154–8. PMID 9635600.
  27. ↑ Urbain JL, Vekemans MC, Parkman H, Van Cauteren J, Mayeur SM, Van den Maegdenbergh V, Charkes ND, Fisher RS, Malmud LS, De Roo M (1995). "Dynamic antral scintigraphy to characterize gastric antral motility in functional dyspepsia". J. Nucl. Med. 36 (9): 1579–86. PMID 7658213.
  28. ↑ Hejazi RA, Lavenbarg TH, McCallum RW (2010). "Spectrum of gastric emptying patterns in adult patients with cyclic vomiting syndrome". Neurogastroenterol. Motil. 22 (12): 1298–302, e338. doi:10.1111/j.1365-2982.2010.01584.x. PMID 20723071.
  29. ↑ "Gastric outlet obstruction - an overview | ScienceDirect Topics".
  30. ↑ Minami H, McCallum RW (1984). "The physiology and pathophysiology of gastric emptying in humans". Gastroenterology. 86 (6): 1592–610. PMID 6370777.
  31. ↑ Humphries LL, Adams LJ, Eckfeldt JH, Levitt MD, McClain CJ (1987). "Hyperamylasemia in patients with eating disorders". Ann. Intern. Med. 106 (1): 50–2. PMID 2431640.
  32. ↑ Hempen I, Lehnert P, Fichter M, Teufel J (1989). "[Hyperamylasemia in anorexia nervosa and bulimia nervosa. Indication of a pancreatic disease?]". Dtsch. Med. Wochenschr. (in German). 114 (49): 1913–6. doi:10.1055/s-2008-1066848. PMID 2480214.
  33. ↑ Okada R, Okada A, Okada T, Okada T, Hamajima N (2009). "Elevated serum lipase levels in patients with dyspepsia of unknown cause in general practice". Med Princ Pract. 18 (2): 130–6. doi:10.1159/000189811. PMID 19204432.
  34. ↑ Sansone RA, Sansone LA (2012). "Hoarseness: a sign of self-induced vomiting?". Innov Clin Neurosci. 9 (10): 37–41. PMC 3508961. PMID 23198276.
  35. ↑ Tack J, Caenepeel P, Arts J, Lee KJ, Sifrim D, Janssens J (2005). "Prevalence of acid reflux in functional dyspepsia and its association with symptom profile". Gut. 54 (10): 1370–6. doi:10.1136/gut.2004.053355. PMC 1774686. PMID 15972301.
  36. ↑ "gut.bmj.com" (PDF).
  37. ↑ Boles RG, Williams JC (1999). "Mitochondrial disease and cyclic vomiting syndrome". Dig. Dis. Sci. 44 (8 Suppl): 103S–107S. PMID 10490048.
  38. ↑ Ranasinghe WK, Smith M (2013). "Gastric outlet obstruction with an elevated serum pancreatic lipase secondary to an infraumbilical hernia". Ann R Coll Surg Engl. 95 (7): 122–4. doi:10.1308/003588413X13629960047795. PMID 24112485.
  39. ↑ Ui, Takashi; Shibusawa, Hiroyuki; Tsukui, Hidenori; Sakuma, Kazuya; Takahashi, Shuhei; Lefor, Alan K.; Hosoya, Yoshinori; Sata, Naohiro; Yasuda, Yoshikazu (2015). "Pretreatment of gastric outlet obstruction with pancrelipase: Report of a case". International Journal of Surgery Case Reports. 12: 87–89. doi:10.1016/j.ijscr.2015.05.023. ISSN 2210-2612.
  40. ↑ Hyams JS. "Functional Disorders: Children and Adolescents. Gastroenterology". PMID 27144632. Check |pmid= value (help).
  41. ↑ Kessing BF. "Objective manometric criteria for the rumination syndrome". PMID 24366235. Check |pmid= value (help).
  42. ↑ Singendonk M. "Objectively diagnosing rumination syndrome in children using esophageal pH-impedance and manometry. Neurogastroenterol Motil". PMID 28078818. Check |pmid= value (help). Vancouver style error: initials (help)
  43. ↑ Puoti MG. "he role of high-resolution impedance manometry to identify rumination syndrome in children with unexplained foregut symptoms. Neurogastroenterol Motil". PMID 38385686. Check |pmid= value (help).
  44. ↑ Brockbank EM. "MERYCISM OR RUMINATION IN MAN. Neurogastroenterol Motil". PMID 20763087. Check |pmid= value (help).
  45. ↑ Blondeau K. "Baclofen improves symptoms and reduces postprandial flow events in patients with rumination and supragastric belching. Neurogastroenterol Motil". PMID 22079512. Check |pmid= value (help).
  46. ↑ 47.0 47.1 47.2 47.3 Diagnostic and statistical manual of mental disorders : DSM-5. Washington, D.C: American Psychiatric Association. 2013. ISBN 0890425558.
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