What is rumination syndrome?

Rumination syndrome is a rare behavioral problem. It affects children, adolescents and some adults. Rumination syndrome causes an automatic regurgitation of recently eaten food. If your child has this problem, he or she will usually eat meals normally. But, after about an hour or two, undigested food comes back up into his or her mouth from the esophagus. Your child will either re-chew and re-swallow the food, or spit it out. Usually, this happens at every meal, day after day. Rumination is a reflex, not a conscious action.

Rumination syndrome is a rare problem. However, it may be under diagnosed because it is mistaken for another problem.

Although still rare, rumination is being diagnosed more often in both children and adults. Experts think this may be happening because health care providers are now able to spot the problem. Then they can diagnose it. Rumination is not actually happening more often.

What causes rumination syndrome?

Experts think rumination is unconscious. However, they also believe that the voluntary muscle relaxation of the diaphragm becomes a learned habit. It is similar to the typical belching reflex. But rather than burping up gas, the reflex causes actual food to come back up.

What are the symptoms of rumination syndrome?

Rumination is different from throwing up. With rumination, the food is undigested and often still tastes the same as when it was first eaten.

The symptoms of rumination syndrome may look like other medical conditions or problems. Always talk with your health care provider for a diagnosis.

How is rumination syndrome diagnosed?

Since throwing up is much more common, rumination syndrome is often misdiagnosed as a vomiting disorder, such as delayed digestion (gastroparesis) or GERD or heartburn (gastroesophageal reflex disease).

To diagnose rumination, health care providers need to ask the right questions. For instance, asking what the food tastes like when it comes up is important. If it still tastes good, this means the food was not digested. This means that rumination syndrome is a good possibility. Vomited food has been digested and typically is not kept in the mouth.

The symptoms of rumination syndrome do not get better with usual treatment of reflux.

How is rumination syndrome treated?

Specific treatment for rumination syndrome will be decided by your health care provider based on the following:

• How bad the problem is

• Your age, overall health, and medical history

• Your tolerance for specific medications, procedures, or therapies

• Outlook for the course of the disorder

• The opinion of the health care providers involved in your care

• Your opinion and preferences

There aren’t any drugs available that effectively treat rumination syndrome. The best way to stop it is to re-learn how to eat and digest food properly. This requires diaphragmatic breathing training.

A behavioral psychologist usually teaches this, and it's easy to learn. The technique has to be used at the start of every meal to avoid regurgitation. Over time, most people can master the breathing technique. This will stop the bad symptoms of rumination syndrome.

Can rumination syndrome be prevented?

Experts aren't sure why rumination syndrome starts in the first place. So it's unclear what can be done to prevent it.

Living with rumination syndrome

The good news about rumination syndrome is that it doesn't seem to do much physical damage. In rare instances, it can cause problems with the esophagus from the acid and reflux. In some teens and adults, it has caused a small amount of weight loss.

Work with your health care provider or your child's health care provider to know the symptoms. Then work with a behavioral psychologist to end the pattern. 

When should I call my health care provider?

If your symptoms get worse or you have new symptoms, tell your health care provider.

Key points

• Rumination syndrome is a rare behavioral disorder in which food is brought back up from the stomach. It is either re-chewed, re-swallowed, or spit out.

• The food will be described as tasting normally and not acidic-tasting, like vomit. This means it is still undigested.

• This problem is a psychological disorder. It may be mistaken for vomiting or other digestive problems.

• Behavioral therapy will help you to notice the pattern and work to correct it.

• Rumination syndrome should be considered in anyone who vomits after eating, has regurgitation, and weight loss.

Next steps

Tips to help you get the most from a visit to your health care provider:

• Before your visit, write down questions you want answered.

• Bring someone with you to help you ask questions and remember what your provider tells you.

• At the visit, write down the names of new medicines, treatments, or tests, and any new instructions your provider gives you.

• If you have a follow-up appointment, write down the date, time, and purpose for that visit.

• Know how you can contact your provider if you have questions.