Rumination syndrome is a condition in which people repeatedly and unintentionally spit up (regurgitate) undigested or partially digested food from the stomach, rechew it, and then either reswallow the food or spit it out. The food hasn't been digested, so people with rumination syndrome often report that the food tastes normal, not acidic like vomit. Rumination typically occurs every day, and at every meal, usually within 30 minutes of eating.

The precise cause of rumination syndrome is unknown, but it's clear that rumination is a subconscious behavior, not a conscious decision. Rumination syndrome is frequently confused with bulimia nervosa, gastroesophageal reflux disease (GERD) and gastroparesis. Some people have rumination syndrome and constipation caused by a rectal evacuation disorder.

The condition has long been known to occur in infants and people with developmental disabilities, which may be related to an unvoiced desire to reject food. But it can also occur in other children, adolescents and adults. It's not clear how many people have this disorder.

  • Diagnostic expertise. Mayo Clinic doctors have significant experience distinguishing rumination syndrome from other digestive conditions. Experts from Mayo Clinic have been involved in the largest studies done on rumination syndrome, including the identification of other conditions that can occur with rumination syndrome, and the best treatments for the disorder. Each year, Mayo Clinic doctors treat about 65 people with rumination syndrome.
  • Effective treatment. At Mayo Clinic, your treatment team includes behavioral psychologists who teach breathing techniques that can prevent rumination. This treatment is generally effective for most people.

Mayo Clinic in Rochester, Minn., ranks No. 1 for digestive disorders in the U.S. News & World Report Best Hospitals rankings. Mayo Clinic in Scottsdale, Ariz., and Mayo Clinic in Jacksonville, Fla., are ranked among the Best Hospitals for digestive disorders by U.S. News & World Report.

Mayo Clinic doctors start by obtaining an accurate medical history and asking about symptoms. This initial exam, and sometimes observation of a person's behavior, may be enough to diagnose rumination syndrome.

While the diagnosis can be made in the vast majority of cases with a careful history, high-resolution esophageal manometry and impedance measurement can be used to confirm the diagnosis. This testing also provides an image of the disordered function for use in biofeedback. Biofeedback is part behavioral therapy for rumination syndrome. During biofeedback, the imaging can help the patient diaphragmatic breathing skills to counteract regurgitation.

Mayo doctors may sometimes use other tests to rule out other causes of symptoms of rumination syndrome:

  • Esophagogastroduodenoscopy. This test allows your doctor to inspect your esophagus, stomach and the upper part of your small intestine (duodenum) to rule out any obstruction. The doctor may remove a small tissue sample (biopsy) for further study.
  • Gastric emptying. This procedure lets your doctor know how long it takes food containing a marker to empty from your stomach. Another version of this test also can measure how long it takes food to travel through your small intestine and colon.

Another test — called single-photon emission computerized tomography (SPECT) of the stomach — lets your doctor see how your stomach functions, and is helpful in deciding whether or not to use medications to relax the stomach. A SPECT scan is a type of nuclear imaging test, which means it uses a radioactive substance and a special camera to create 3-D pictures.

Treatment depends on the exclusion of other disorders, as well as on the person's age and cognitive ability. At Mayo Clinic, digestive disease specialists (gastroenterologists) work closely with pediatricians and psychologists to treat people with rumination syndrome.

Behavior therapy

Mayo Clinic specialists typically use habit reversal behavior therapy to treat people without developmental disabilities who have rumination syndrome. People learn to recognize when rumination occurs, and to breathe in and out with the abdominal muscles (diaphragmatic breathing) during those times. Diaphragmatic breathing prevents abdominal contractions and regurgitation.

For people who have mental or developmental disabilities, such behavioral treatment may not be possible. Treatment may involve mild aversive training — associating rumination with negative consequences — or other behavioral techniques.

For infants, treatment usually focuses on working with parents or caregivers to change the infant's environment and behavior.


If frequent rumination is damaging the esophagus, proton pump inhibitors may be prescribed. These medications can protect the lining of the esophagus until behavior therapy reduces the frequency and severity of regurgitation.

Some people with rumination syndrome may benefit from treatment with medication that helps relax the stomach in the period after eating.

Untreated, rumination syndrome can damage the tube between your mouth and stomach (esophagus) and cause unhealthy weight loss.

Mayo Clinic works with hundreds of insurance companies and is an in-network provider for millions of people. In most cases, Mayo Clinic doesn't require a physician referral. Some insurers require referrals or may have additional requirements for certain medical care. All appointments are prioritized on the basis of medical need.

Specialists in gastroenterology and psychiatry and psychology usually manage care for adults who have rumination syndrome.

For appointments or more information, call the Central Appointment Office at 800-446-2279 (toll-free) 8 a.m. to 5 p.m. Mountain Standard Time, Monday through Friday or complete an online appointment request form.

Specialists in gastroenterology and psychiatry and psychology usually manage care for adults who have rumination syndrome.

For appointments or more information, call the Central Appointment Office at 904-953-0853 8 a.m. to 5 p.m. Eastern time, Monday through Friday or complete an online appointment request form.

Specialists in gastroenterology, pediatrics and psychiatry and psychology usually manage care for children and adults who have rumination syndrome.

7 a.m. to 6 p.m. Central time, Monday through Friday

Mayo Clinic researchers are working to improve diagnosis and treatment for people with rumination syndrome. Specific efforts involve learning more about the cause of rumination syndrome, and educating other physicians about this little-known condition.

See a list of publications by Mayo Clinic authors on rumination syndrome on PubMed, a service of the National Library of Medicine.

Oct. 15, 2015