Rumination syndrome is a condition in which people repeatedly and unintentionally spit up (regurgitate) undigested food from the stomach, rechew it, and then either reswallow the food or spit it out. Rumination is a reflex, not a conscious decision. Rumination syndrome may go undiagnosed because it is often confused with other conditions.

About

People with rumination syndrome repeatedly regurgitate small amounts of food from the stomach without trying to do so. The food is then partially or completely rechewed and reswallowed or spit out. The food hasn't been digested, so people with rumination syndrome often report that the food tastes normal, not acidic like vomit.

Rumination syndrome is frequently confused with bulimia nervosa, gastroesophageal reflux disease (GERD) and gastroparesis. The condition has long been known to occur in infants and people with developmental disabilities. But it can also occur in other children, adolescents and adults.

The precise cause is unknown. Rumination may be an unconscious, learned behavior that involves the belch reflex. Untreated, rumination syndrome can damage the tube between your mouth and stomach (esophagus) and cause unhealthy weight loss.

  • Diagnostic expertise. Mayo Clinic doctors have experience distinguishing this rare syndrome from other digestive conditions.
  • 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.
  • New ideas. Mayo Clinic doctors are continuing research to better understand the cause of rumination syndrome, and how to treat it. You have access to the expertise of Mayo's clinician-researchers.

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 high performing for digestive disorders by U.S. News & World Report.

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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.

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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.

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

  • Esophagogastroduodenoscopy. Allows your doctor to inspect your esophagus, stomach and upper part of the small intestine (duodenum). The doctor may remove a small tissue sample (biopsy) for further study.
  • Gastroduodenal manometry. Tests the muscles involved in digestion.
  • Gastric emptying. Tests how long it takes food containing a radioactive marker to empty from your stomach. Another version of this test also can measure how long it takes food to travel through the small intestine and colon.
  • Ultrasound or contrast X-rays. May be used in infants to rule out hiatal hernia and narrowing of the opening from the stomach to the small intestine (pyloric stenosis).

Symptoms

Symptoms vary from person to person, but regurgitation typically:

  • Is effortless, as opposed to forced vomiting
  • Isn't associated with heartburn, abdominal pain or nausea
  • Begins within 30 minutes of eating a meal
  • Stops within 60 minutes
  • Doesn't occur while lying down or sleeping
  • Doesn't respond to standard treatment for GERD

Treatment depends on the presence of other disorders, and 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 thus regurgitation.

For people who have developmental disabilities, treatment may involve mild aversive training — associating rumination with negative consequences — or other behavioral techniques. For people with rumination syndrome who also have bulimia nervosa, treatment focuses on the eating disorder.

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

Medication

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.

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.

Publications

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

Nov. 20, 2012