Rumination disorder is the backward flow of recently eaten food from the stomach to the mouth. The food is then re-chewed and swallowed or spat out. A non-purposeful contraction of stomach muscles is involved in rumination. It may be initially triggered by a viral illness, emotional distress, or physical injury. In many cases, no underlying trigger is identified. Behavioral therapy is the mainstay of treatment.
Diagnosis can be made by a clinical evaluation of the person’s signs and symptoms and history. The following diagnostic criteria is used to aid in diagnosis. These criteria must be met for the last 3 months, with symptoms beginning at least 6 months prior to diagnosis:
1. Repeated regurgitation and rechewing or expulsion of food that
a. Begins soon after eating
b. Does not occur during sleep
c. Does not respond to standard treatment for GERD
2. No Retching
3. Symptoms are not explained by inflammatory, anatomic, metabolic, or neoplastic processes
These criteria help distinguish rumination syndrome from other disorders of the GI tract, such as gastroparesis and achalasia where vomiting occurs hours after eating, gastroesophageal reflux where symptoms occur at night, and cyclic vomiting syndrome where the symptoms are chronic/persistent.
Antroduodenal manometry can assist in making and confirming the diagnosis. Antroduodenal manometry involves putting a catheter through the nose into the stomach and small bowel to measure pressure changes.
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