Rare Immunology News

Disease Profile

Rumination disorder

Prevalence
Prevalence estimates on Rare Medical Network websites are calculated based on data available from numerous sources, including US and European government statistics, the NIH, Orphanet, and published epidemiologic studies. Rare disease population data is recognized to be highly variable, and based on a wide variety of source data and methodologies, so the prevalence data on this site should be assumed to be estimated and cannot be considered to be absolutely correct.

Unknown

Age of onset

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ICD-10

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Inheritance

Autosomal dominant A pathogenic variant in only one gene copy in each cell is sufficient to cause an autosomal dominant disease

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Autosomal recessive Pathogenic variants in both copies of each gene of the chromosome are needed to cause an autosomal recessive disease and observe the mutant phenotype

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X-linked
dominant X-linked dominant inheritance, sometimes referred to as X-linked dominance, is a mode of genetic inheritance by which a dominant gene is carried on the X chromosome.

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X-linked
recessive Pathogenic variants in both copies of a gene on the X chromosome cause an X-linked recessive disorder

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Mitochondrial or multigenic Mitochondrial genetic disorders can be caused by changes (mutations) in either the mitochondrial DNA or nuclear DNA that lead to dysfunction of the mitochondria and inadequate production of energy.

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Multigenic or multifactor Inheritance involving many factors, of which at least one is genetic but none is of overwhelming importance, as in the causation of a disease by multiple genetic and environmental factors.

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Not applicable

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Other names (AKA)

Rumination syndrome

Summary

Rumination disorder is the backward flow of recently eaten food from the stomach to the mouth. The food is then re-chewed and swallowed or spat out. A non-purposeful contraction of stomach muscles is involved in rumination. It may be initially triggered by a viral illness, emotional distress, or physical injury. In many cases, no underlying trigger is identified. Behavioral therapy is the mainstay of treatment.[1][2]

 

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Symptoms

Signs and symptoms of rumination disorder includes the backward flow of recently eaten food from the stomach to the mouth. This typically occurs immediately to 15 to 30 minutes after eating. Rumination often occurs without retching or gagging. Rumination may be proceeded by a feeling of pressure, the need to belch, nausea, or discomfort. Some people with rumination disorder experience bloating, heartburn, diarrhea, constipation, abdominal pain, headaches, dizziness, or sleeping difficulties. Complications of severe disorder include weight loss, malnutrition, and electrolyte imbalance.[2]

Cause

Rumination disorder may occur following a viral illness, emotional stress, or physical injury.[2] It is theorized that while the initial stressor improves, an altered sensation in the abdomen persists. This ultimately results in the relaxation of the muscle at the bottom of the esophagus. To relieve this discomfort people with rumination disorder use abdominal wall muscles to expel and regurgitate foods. As a result of the relief of symptoms, the person repeats the same response when the discomfort returns. Overtime the person unconsciously adopts this learned behavior.

Some cases of rumination disorder occur without a precipitating event or illness. Other people with the disorder describe also having ingestion, which may serve as a trigger. Studies have shown that some people with rumination disorder also have depression, anxiety, or an eating disorder. These conditions may likewise play a role in rumination disorder. Conditions like depression and anxiety are known to be more common in people with other functional gastrointestinal conditions as well, for example irritable bowel syndrome.[2]

Diagnosis

Diagnosis can be made by a clinical evaluation of the person’s signs and symptoms and history. The following diagnostic criteria is used to aid in diagnosis.[1][2] These criteria must be met for the last 3 months, with symptoms beginning at least 6 months prior to diagnosis:[2]

1. Repeated regurgitation and rechewing or expulsion of food that

a. Begins soon after eating
b. Does not occur during sleep
c. Does not respond to standard treatment for GERD

2. No Retching

3. Symptoms are not explained by inflammatory, anatomic, metabolic, or neoplastic processes

These criteria help distinguish rumination syndrome from other disorders of the GI tract, such as gastroparesis and achalasia where vomiting occurs hours after eating, gastroesophageal reflux where symptoms occur at night, and cyclic vomiting syndrome where the symptoms are chronic/persistent.[2]

Antroduodenal manometry can assist in making and confirming the diagnosis.[1][2] Antroduodenal manometry involves putting a catheter through the nose into the stomach and small bowel to measure pressure changes.

Treatment

The main treatment of rumination disorder is behavioral therapy. This may involve habitat reversal strategies, relaxation, diaphragmatic breathing, and biofeedback. These types of therapies can often be administered by a gastroenterologist.[2] Other professionals, such as nurse practitioners, psychologists, massage therapists, and recreational therapists may also be involved in care. Ensuring adequate nutrition is essential and treatment will also involve managing other symptoms, such as anxiety, nausea and stomach discomfort (which may involve anti-depressive agents or SSRI’s).[2]

If behavioral therapy is unsuccessful, treatment with baclofen may be considered. There is limited data regarding optimal treatment of rumination disorder, but success with baclofen has been reported.[2]

Organizations

Support and advocacy groups can help you connect with other patients and families, and they can provide valuable services. Many develop patient-centered information and are the driving force behind research for better treatments and possible cures. They can direct you to research, resources, and services. Many organizations also have experts who serve as medical advisors or provide lists of doctors/clinics. Visit the group’s website or contact them to learn about the services they offer. Inclusion on this list is not an endorsement by GARD.

Organizations Providing General Support

    Learn more

    These resources provide more information about this condition or associated symptoms. The in-depth resources contain medical and scientific language that may be hard to understand. You may want to review these resources with a medical professional.

    Where to Start

      In-Depth Information

      • Medscape Reference provides information on this topic. You may need to register to view the medical textbook, but registration is free.
      • The Monarch Initiative brings together data about this condition from humans and other species to help physicians and biomedical researchers. Monarch’s tools are designed to make it easier to compare the signs and symptoms (phenotypes) of different diseases and discover common features. This initiative is a collaboration between several academic institutions across the world and is funded by the National Institutes of Health. Visit the website to explore the biology of this condition.
      • PubMed is a searchable database of medical literature and lists journal articles that discuss Rumination disorder. Click on the link to view a sample search on this topic.

        Selected Full-Text Journal Articles

          References

          1. Kessing BF, Smout AJ, Bredenoord AJ. Current diagnosis and management of the rumination syndrome. J Clin Gastroenterol. 2014 Jul; 48(6):478-83. https://www.ncbi.nlm.nih.gov/pubmed/ 24921208. Accessed 4/23/2015.
          2. Mousa HM, Montgomery M, Alioto A. Adolescent rumination syndrome. Curr Gastroenterol Rep. 2014 Aug; 16(8):398. https://www.ncbi.nlm.nih.gov/pubmed/25064317. Accessed 4/23/2015.

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