What is Rumination Disorder?
Rumination disorder (RD) is a feeding and eating disorder characterized by frequent episodes of spitting up (regurgitating) food from the stomach into the mouth after eating. After the food is regurgitated, it is re-chewed and either re-swallowed or spit out. In people with the disorder, this type of regurgitation occurs during or after almost every meal and is usually considered to be a reflex rather than intentional behavior.
The regurgitation associated with rumination disorder differs from vomiting. In RD, the food is typically spat up with an effortless sensation that resembles a belch, not the retching associated with vomiting. The regurgitated food is undigested and tastes normal, unlike vomit, and there is often no nausea associated with RD.
Symptoms of Rumination Disorder
Potential symptoms of RD include:
- Persistent regurgitation and re-chewing of food that happens during or after nearly every meal
- Effortless regurgitation following a reflex that feels like a belch
- Stomach aches
- Bad breath
- Tooth decay
- Weight loss
What Causes Rumination Disorder?
The precise cause of rumination disorder is unclear, but scientists think it usually develops as a learned behavior following persistent feelings of fullness or pressure in the stomach. There may be physical reasons for the feelings of fullness, but some people seem to be at increased risk of developing RD behaviors in response to the fullness. Some risk factors for RD include:
- Age. RD is more common in babies and children.
- Developmental disabilities
- Chronic stress
Is Rumination Disorder Hereditary?
Research on a possible inherited component of rumination disorder is limited, and there is no solid indication that the disorder is linked to genetics. However, there have been case studies that suggest the disorder can run in families, so it is possible that genes could play some role.
How Is Rumination Disorder Detected?
Rumination disorder may be challenging to diagnose because its symptoms can resemble those of other gastrointestinal conditions or eating disorders. Doctors must be careful to differentiate RD from other problems with similar symptoms
Other conditions sometimes confused with RD include:
- Gastroesophageal reflux disease (GERD)
- Pyloric stenosis
- Bulimia nervosa
How Is Rumination Disorder Diagnosed?
To diagnose rumination disorder, doctors look for a pattern of symptoms and risk factors. The diagnostic process will also likely include exams to look for medical conditions that could be causing the symptoms. The diagnostic process usually includes physical examinations, tests, and a medical and family history review.
Diagnostic steps may include:
- A physical exam. This exam aims to rule out specific physical conditions that could be causing the symptoms.
- Blood and laboratory tests. These tests will look at the patient’s blood chemistry for issues that may be causing the symptoms.
- Other exams and tests. Tests and exams such as a gastric emptying test, endoscopy, or x-rays may be used to rule out medical problems that could be causing the symptoms.
- Psychological assessments. These assessments may take the form of questionnaires or talk sessions with a mental health professional to look for symptoms of rumination disorder and signs of depression or other mental issues that may underlie the symptoms. The assessment results will be compared to the diagnostic criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) to determine whether an official diagnosis of rumination disorder is appropriate.
The DSM-5 diagnostic criteria for rumination disorder include:
- Repeated regurgitation of food for at least one month.
- A medical condition does not cause the regurgitation.
- The regurgitation is not caused by another eating disorder, such as anorexia nervosa, bulimia nervosa, binge eating disorder, or avoidant restrictive food intake disorder (ARFID).
- If another mental or developmental disorder is present, the regurgitation is severe enough to warrant medical care on its own.
How Is Rumination Disorder Treated?
Treatment for rumination disorder usually focuses on teaching the person to recognize the physical feelings associated with regurgitation and change the habits associated with those feelings. Treatment approaches can include:
- Diaphragmatic breathing training. This therapy teaches a breathing technique that can help control the regurgitation reflex.
- Habit reversal behavior training
- Medications such as esomeprazole or omeprazole may be used to protect the esophagus from damage until the regurgitation behavior is under control
How Does Rumination Disorder Progress?
Rumination disorder usually doesn’t cause severe physical complications, but left untreated, the disorder may lead to health problems. Possible complications of long-term rumination disorder include:
- Damage to the esophagus
- Inhalation of food into the lungs
- Electrolyte imbalances
- Weight loss
- Social isolation
- Problems in school
How Is Rumination Disorder Prevented?
There is no sure way to prevent rumination disorder, but managing stress, anxiety, or depression may help some people control RD symptoms if those mental health-related issues underlie the RD behavior.
Rumination Disorder Caregiver Tips
Many people with rumination disorder also suffer from other brain and mental health-related issues, a situation called co-morbidity. Here are a few of the disorders commonly associated with RD:
Rumination Disorder Brain Science
The symptoms of rumination are caused by real physiological reactions in the gastrointestinal (GI) system, but the underlying cause of the disorder appears to lie in dysfunctional communication between the brain and the GI system. Sometimes the initial regurgitation may be triggered by an illness or a GI disorder, or it may happen in reaction to a stressful event or trauma. However, in the case of RD, the regurgitation behavior continues after the triggering event is gone. This could be because the person has learned to associate the physical feelings of eating with the act of regurgitation, resulting in involuntary regurgitation whenever they consume food.
Rumination Disorder Research
Title: Use of Intrapyloric Botulinum Injections in Children
Principal investigator: Rachel Rosen, MD, MPH
Boston Children’s Hospital
This study aims to evaluate the effect of intrapyloric botulinum toxin in children with feeding disorders.
Chronic vomiting and feeding difficulties are common in young children and have a negative physical and psychosocial impact on patients and families. Currently, there is no straightforward treatment algorithm for these issues, and management often involves multiple medication trials and procedures. Intrapyloric botulinum toxin injection has been proposed as a treatment for nausea and vomiting in adults. Still, there is minimal prior research on use in children and no prior research on use in children with feeding disorders. The aims of this study are: (1) to determine the efficacy of intrapyloric botulinum toxin injection for reducing gastrointestinal symptoms in children, (2) to determine the efficacy of intrapyloric botulinum injections for improving feeding outcomes in children, and (3) to define predictors of response to intrapyloric botulinum toxin injection.
Title: Brain Function in Adolescent Eating Disorders and Healthy Peers
Principal investigator: Christina Wierenga, PhD
University of California, San Diego
San Diego, CA
This study of adolescent eating disorders (ED) will examine the association of temperament-based classifications, brain activation during incentive processing, and ED symptoms at the time of scan and 1 year later to better understand the neurobiology and symptoms of ED. We will recruit 150 females currently ill with an ED and 50 controls ages 14-17 to investigate how temperaments reflecting greater inhibition, impulsivity, or effortful control correspond to 1) clinical symptoms and 2) the brain’s response to anticipation and outcome of salient stimuli, and 3) by collecting follow-up clinical data one year later, identify how temperament-based subtypes predict ED symptom change (e.g., clinical prediction). Data collection will rely on functional magnetic resonance imaging (fMRI) technology.
Title: Pilot of Reconnecting to Internal Sensations and Experiences in Undergraduates (RISE)
Contact: April R. Smith, PhD
Project RISE is a randomized control trial. The intervention consists of four modules that focus on multiple aspects of interoception, including body awareness, body sensations/movement, eating, health and self-care, emotional awareness, and understanding the self in relation to others. The comparator condition is called “Health Habits” and is matched for time and attention; participants complete modules related to healthy habits such as financial planning, hygiene, stretching, and healthy eating. Variables of interest include self-report measures of interoception, eating pathology, suicidality, physiological measures of interoception (electrocardiograph; ECG; pain tolerance measured via algometer), and an implicit association test (IAT) with death and life stimuli (meant to measure implicit associations with suicidality). The population will be college students with current or past suicidality or low interoception.