Rumination syndrome: when to suspect and how to treat

Rumination syndrome is a gastrointestinal disorder characterized by effortless regurgitation of recently ingested food. The disorder is rare, but likely under-recognized and leads to impaired quality of life among those affected. This review discusses recent studies which examined the pathophysiology, diagnoses and therapy of rumination syndrome.

The pathogenesis of rumination syndrome remains incompletely understood. Therapeutic options, which appear effective, include behavioral therapy with diaphragmatic breathing and pharmacotherapy with baclofen. A randomized trial of behavioral therapy, biofeedback therapy led to a 74% + /- 6% reduction in rumination activity (from 29  + /- 6 before to 7 + /- 2 daily events after intervention) vs. 1% + /- 14% during sham (from 21 + /- 2 before to 21 + /- 4 daily events after intervention) (P = .001). A recent randomized trial of baclofen at a dose of 10 mg three times daily led to symptomatic improvement in 63% of patients with rumination syndrome.

This review summarizes a clinical approach to diagnosing and treating rumination syndrome. Behavioral therapy consisting of diaphragmatic breathing, with or without biofeedback, remains the most effective treatment strategy for patients with rumination syndrome.