Overview.
Rumination syndrome is a condition in which food that has been ingested for a short period of time is returned to the mouth, chewed again, and then swallowed or spit out without effort, and is not accompanied by abdominal discomfort, heartburn, or nausea. It is usually not offensive to the patient and is even accompanied by a satisfying experience. It is more common in males, occurs most often in infants and psychologically disturbed children and adults and can have fatal complications (aspiration pneumonia). It can also occur in people with normal intelligence, usually in young patients. There is often a family history. The disease is often misdiagnosed as gastroesophageal reflux disease.
Etiology
The pathogenesis of regurgitation is unclear and may be initiated by belching or swallowing, when reduced lower esophageal sphincter (LES) pressure creates a common lumen between the gastroesophagus. It is sometimes caused by finger or tongue irritation of the palate and pharynx. Regurgitation in normally developing children may be caused by positive feedback in response to parental attention and concern or by the taste of regurgitated food. It has also been suggested that regurgitation occurs in association with waves of simultaneous esophageal and gastric contractions, possibly due to a sudden increase in intra-abdominal pressure. Some scholars believe that regurgitation is a skilled belching reflex process in adults of normal intelligence because of the prolonged relaxation of the LES during belching.
Symptoms
It manifests as repeated regurgitation of partially undigested food into the mouth. Symptoms usually appear within 10 minutes of eating and may persist until 1 to 2 hours after a meal. It is characterized by cessation when the food becomes sour. Weight loss is common and may be associated with spitting refluxed food out. Some patients exhibit bulimia nervosa and vomit out refluxed food in an attempt to control their weight. Regurgitation is not harmful to health, but some children can experience weight loss or unfavorable physical development as a result.
Examination
1. Laboratory examination
During gastroduodenal manometry, pressure peaks (called R waves) are seen, creating the illusion of a sudden increase in abdominal pressure.
2. Radiologic imaging
Upper gastrointestinal imaging is normal and can be used to exclude other diseases. Gastric emptying scan can be used to exclude gastroparesis.
Diagnosis
The diagnostic criteria are: (1) persistent or recurrent reflux of recently ingested food into the mouth for re-chewing and swallowing; (2) absence of nausea and vomiting; (3) cessation of the process when the refluxed material becomes acidic; and (4) absence of asymptomatic gastroesophageal reflux, cardia flaccidis, or other dynamical disorders, for at least 12 weeks in the past 1 year.
Differential Diagnosis
Differential diseases include GERD, cardia laxity, gastroparesis, vomiting, obstruction and pseudo-obstruction.
Treatment
For adult patients with normal intelligence, treatment is based on education and explanation, and biofeedback therapy may be used. For mentally retarded patients, behavioral restriction therapy may be used. There is no need for medication or surgery.