Rumination Syndrome

Rumination syndrome (RS) is a feeding and eating disorder defined by repeated regurgitations of food material soon after eating, followed by re-swallowing, or spitting of the material (Murray, 2019). The first report of rumination was back in the 17th century when Edouard Brown Sequard, a physician, developed the learned behavior of regurgitations while experimenting with swallowing sponges to study gastric acid responses (Khan, 1998). Although the disorder was recognized and medicalized, few studies have been done since to study the disorder in detail. Therefore, the diagnosis of RS varies across different studies, often leading to it being misdiagnosed or undiagnosed. For instance, RS is often misdiagnosed for other conditions that cause vomiting, like gastroesophageal reflux disease and gastroparesis (Khan, 1998). The universal criterion for RS is repeated episodes of regurgitations that last more than a month and are not primarily caused by medical conditions or other eating disorders (Bryant‐Waugh, 2018).

​The cause of RS is unknown, but several hypotheses have tried to explain the mechanisms behind the disorder. One hypothesis is that RS is a conditioned response to a specific stimulus. For instance, regurgitating after eating certain foods may trigger the same response when eating that same food. In other cases, individuals may feel a visceral sensation of pressure in the esophagus and abdomen, followed by a premonitory urge to regurgitate. After regurgitating, individuals are relieved of this urge and the abdominal wall contraction, which may positively reinforce the regurgitation behavior. Other hypotheses pose that the soothing sensation caused by regurgitation may serve as a coping mechanism to relieve psychological distress (Murray, 2019).
Despite the lack of research on the disorder, proper and timely diagnosis and treatment of RS is necessary. Without proper diagnosis and treatment, RS can cause severe health problems, like dental damage, electrolyte imbalance, nausea, abdominal pain, heartburn, and nutrient deficiency (Murray, 2019; Khan. 1998). Currently, the first line of treatment is diaphragmatic breathing, which is a breathing exercise to strengthen the diaphragm. Such exercises have been shown to help contain the food material in the stomach. Other intervention methods, like relaxation, aversion training, distractions, or cognitive behavioral therapy can also enhance treatment. In some cases, medications like Baclofen or neuromodulators may help relieve the symptoms (Murray, 2019). However, more research is warranted to study the mechanisms behind the disorder and how to diagnose best and treat it.   
References
Bryant‐Waugh, R., Micali, N., Cooke, L., Lawson, E. A., Eddy, K. T., & Thomas, J. J. (2018). Development of the PICA, Arfid, and rumination disorder interview, a multi‐informant, semi‐structured interview of feeding disorders across the lifespan: A pilot study for ages 10–22. International Journal of Eating Disorders, 52(4), 378–387. https://doi.org/10.1002/eat.22958
Khan, S., Hyman, P., & DiLorenzo, C. (1998). Rumination syndrome in adolescents. Journal of Pediatric Gastroenterology & Nutrition, 27(4), 479. https://doi.org/10.1097/00005176-199810000-00085
Murray, H. B., Juarascio, A. S., Di Lorenzo, C., Drossman, D. A., & Thomas, J. J. (2019). Diagnosis and treatment of rumination syndrome: A critical review. American Journal of Gastroenterology, 114(4), 562–578. https://doi.org/10.14309/ajg.0000000000000060
Vijayvargiya, P., Iturrino, J., Camilleri, M., Shin, A., Vazquez-Roque, M., Katzka, D. A., Snuggerud, J. R., & Seime, R. J. (2014). Novel association of rectal evacuation disorder and rumination syndrome: Diagnosis, comorbidities, and treatment. United European Gastroenterology Journal, 2(1), 38–46. https://doi.org/10.1177/2050640613518774