Chronic regurgitation: a clinical approach to the under-recognised rumination syndrome in adults

A woman in her 20s presented to the emergency department with severe hypokalaemia, resulting in a need for high-dependency unit care. She had a 8-month history of effortless regurgitation of food and significant weight loss. She denied any nausea or retching. A CT angiogram, OGD, enteroscopy, barium meal, MRI abdomen and flexible sigmoidoscopy were normal. The diagnosis of rumination syndrome was suspected from the history and witnessed regurgitation; the diagnosis was confirmed by high resolution oesophageal impedance manometry. The patient was managed with total parenteral nutrition (TPN), behavioural therapy and psychological support. Breathing exercises made a significant improvement to her symptoms. This case emphasises the importance of considering rumination syndrome in young patients presenting with regurgitation of masticated food, in the absence of nausea.