Rumination is one disorder of the gut-brain interaction characterized by (usually involuntary) regurgitation of small amounts of food from the stomach (most often 15 to 30 minutes after eating) that are rechewed and, in most cases, again swallowed.
Patients do not have symptoms of nausea or abdominal pain.
Rumination is more common in adults than children (1).
General reference
1. Haworth JJ, Treadway S, Hobson AR. The prevalence of rumination syndrome and rumination disorder: A systematic review and meta-analysis. Neurogastroenterol Motil. 2024;36(7):e14793. doi:10.1111/nmo.14793
Etiology of Rumination
Patients with achalasia or a Zenker diverticulum may regurgitate undigested food without nausea. In the majority of patients who do not have these obstructive esophageal conditions, the pathophysiology is poorly understood. The reverse peristalsis in ruminants has not been reported in humans.
The disorder is characterized as a behavioral disorder and is associated with eating disorders (1). The person learns to open the lower esophageal sphincter and propel gastric contents into the esophagus and throat by increasing gastric pressure via rhythmic contraction and relaxation of the diaphragm.
Etiology reference
1. Kroon Van Diest AM. Rumination Syndrome. Gastroenterol Clin North Am. 2025;54(3):511-518. doi:10.1016/j.gtc.2025.02.006
Symptoms and Signs of Rumination
Nausea, pain, and dysphagia do not occur.
During periods of stress, the patient may be less careful about concealing rumination. Seeing the act for the first time, others may refer the patient to a physician.
Rarely, patients regurgitate and expel enough food to lose weight.
Diagnosis of Rumination
Primarily history and physical examination
Sometimes endoscopy, esophageal motility studies, or both
Rumination is usually diagnosed through observation. A psychosocial history may disclose underlying emotional stress.
Endoscopy or an upper gastrointestinal series is necessary to exclude disorders causing mechanical obstruction or a Zenker diverticulum.
Esophageal manometry and tests to assess gastric emptying and antral-duodenal motility may be used to identify a motility disturbance (1).
Diagnosis reference
1. Murray HB, Juarascio AS, Di Lorenzo C, et al. Diagnosis and treatment of rumination syndrome: A critical review. Am J Gastroenterol. 2019;114(4):562–578. doi:10.14309/ajg.0000000000000060
Treatment of Rumination
Behavioral techniques
Treatment of rumination is supportive. Motivated patients may respond to behavioral techniques (eg, relaxation, biofeedback, training in diaphragmatic breathing [using the diaphragm instead of chest muscles to breathe]) (1).
Baclofen may help, but long-term safety and efficacy data are limited. Baclofen may help, but long-term safety and efficacy data are limited.
Psychiatric consultation may be helpful.
Treatment reference
1. Murray HB, Juarascio AS, Di Lorenzo C, et al. Diagnosis and treatment of rumination syndrome: A critical review. Am J Gastroenterol. 2019;114(4):562–578. doi:10.14309/ajg.0000000000000060
