Diagnosis

Diagnosis at Mayo Clinic

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

Treatment at Mayo Clinic

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.

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.

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.

Clinical trials

Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this disease.

Rumination syndrome care at Mayo Clinic

Oct. 15, 2015
References
  1. Kessing BF, et al. Current diagnosis and management of the rumination syndrome. Journal of Clinical Gastroenterology. 2014;48:478.
  2. Feeding and eating disorders. In: Diagnostic and Statistical Manual of Mental Disorders DSM-5. 5th ed. Arlington, Va.: American Psychiatric Association; 2013. http://www.psychiatryonline.org. Accessed July 27, 2015.
  3. O'Brien MD, et al. Rumination syndrome: Clinical features rather than manometric diagnosis. Gastroenterology. 1995;108:1024.
  4. Mousa HM, et al. Adolescent rumination syndrome. Current Gastroenterology Report. 2014;16:398.
  5. Talley NJ. Rumination syndrome. Gastroenterology & Hepatology. 2011;7:117.
  6. Vijayvargiya P, et al. Novel association of rectal evacuation disorder and rumination syndrome: Diagnosis, co‑morbidities and treatment. United European Gastroenterology Journal. 2014;2:38.
  7. Camilleri M (expert opinion). Mayo Clinic, Rochester, Minn. Aug. 3, 2015.
  8. Chial HJ, et al. Rumination syndrome in children and adolescents: Diagnosis, treatment and prognosis. Pediatrics 2003;111:158.
  9. Cook AJ. Allscripts EPSi. Mayo Clinic, Rochester, Minn. July 30, 2015.
  10. Hejazi RA, et al. Rumination syndrome: A review of current concepts and treatments. American Journal of Medical Science. 2014;348:324.
  11. Ebert MH, et al., eds. Developmental disorders of attachment, feeding, elimination, & sleeping. In: Current Diagnosis & Treatment: Psychiatry. 2nd ed. New York, N.Y.: The McGraw-Hill Companies; 2008. http://www.accessmedicine. com. Accessed July 27, 2015.