What Is Rumination Disorder?
Rumination disorder, also known as rumination syndrome or merycism, is a feeding and eating disorder in which undigested food comes up from a person’s stomach into their mouth. Once the food is back in the mouth, the person may chew it and swallow it again or spit it out.
This behavior is seen often after every meal and is usually effortless. Rumination is often followed by a sensation of burping or belching and usually does not involve nausea or retching. In rumination, the regurgitated food often does not taste sour or bitter because it had not been fully mixed with stomach acid to be digested.
People who have rumination syndrome are not regurgitating food because of a stomach illness or because they feel sick. This act of regurgitation is a reflex action that is often unintentional.
Rumination syndrome is a rare behavioral problem. It affects both children and adults. Often, it goes underdiagnosed because it is mistaken for another problem. Rumination disorder is frequently confused with bulimia nervosa, gastroesophageal reflux disease (GERD), and gastroparesis.
The majority of the people suffering do not get diagnosed, as the symptom looks similar to any gastric disorder, and hence it is usually brushed off. Treatment of rumination disorder is required as it may lead to life-threatening complexities.
What Causes Rumination Disorder?
The exact cause of rumination disorder is yet to be known. However, some probable causes can be reasons for rumination disorder to occur; some of them are:
1. Increased abdominal pressure.
2. Rectal evacuation disorder.
3. Chronic constipation.
4. Anxiety, depression, or other psychiatric illnesses.
5. People suffering from developmental disabilities.
6. High emotional stress.
7. Relaxed lower esophageal sphincter.
8. Habit induced (history of bulimia nervosa).
9. Trauma induced (recent surgery, psychological distress, or concussion).
What Are the Symptoms of Rumination Disorder?
Rumination disorder presents with certain signs and symptoms. Symptoms of rumination disorder are:
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Involuntary or effortless regurgitation.
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Abdominal pain.
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Halitosis (bad breath).
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Nausea
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Weight loss (unintentional).
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Regurgitation.
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Indigestion.
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Tooth decay (due to the continuous presence of food).
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Chapped lips.
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Gastroesophageal reflux.
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Constipation.
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Diarrhea.
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Bloating.
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Depression and anxiety.
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Erosion of teeth (tooth decay due to acid erosion).
How to Diagnose Someone With Rumination Disorder?
Rumination disorder is often mistaken for gastroesophageal reflux (GERD), eating disorders, etc. Since nausea and vomiting are common symptoms of rumination disorder, it is often misdiagnosed as a vomiting disorder. While diagnosing rumination, healthcare providers ask questions. For example, asking about the taste of food and when it comes up is important. If it does not taste acidic, it means the food was not digested. This suggests rumination disorder as a good possibility. Doctors may perform certain tests to rule out other medical disorders. The tests performed for the diagnosis of rumination disorders are:
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Gastric Emptying Tests: This test is performed to measure how long it takes for food to move from the stomach to the small intestines.
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Upper Endoscopy: The doctor examines the esophagus and stomach with the help of an endoscope (a thin tube with a camera at the end).
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X-Ray: Helps investigate the insides of the esophagus and stomach.
What Is the Treatment of Rumination Disorder?
The principal treatment option for rumination disorder is behavioral therapy to stop regurgitation. The behavioral therapy that is suggested for rumination disorder is diaphragmatic breathing.
The diaphragm is a large, dome-shaped muscle located at the base of the lungs. Diaphragmatic breathing is willed to help relax the diaphragm and help use it correctly while breathing to strengthen it.
To perform diaphragmatic breathing to help control regurgitation, one must:
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Lie on the back on a flat surface, with knees bent and your head supported. Place one hand on the upper chest and the other just below the rib cage. This allows one to feel the diaphragm move while breathing.
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Breathe in slowly through the nose so that the stomach moves out against the hand. Keep the hand as still as possible.
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Tighten the stomach muscles, letting them fall inward with an exhale. Keep the hand on the upper chest as still as possible.
The symptoms of rumination disorder do not get better with the usual treatment of reflux.
Treatment of rumination disorder is based on certain unambiguous symptoms. Specific treatment is assigned for the treatment of specific symptoms. To assign the treatment, the doctor needs to monitor the following criteria:
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Age of the patient.
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Medical history.
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The severity of the symptoms.
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Insurance and indulgence of the patient against specific medications, procedures, and therapies.
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Duration of the illness.
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Professional medical opinion and formal diagnosis.
What Are the Complications of Rumination Disorder?
If left untreated, rumination syndrome leads to damage to the esophagus. Other complications of rumination syndrome are:
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Unhealthy weight loss.
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Malnutrition.
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Embarrassment to eat in public.
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Social isolation.
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Failure to grow (often in infants, children, and teens).
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Electrolyte imbalance.
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Dehydration.
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Aspiration (food lodgement in the airway).
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Choking
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Pneumonia.
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Death (in extreme cases).
Conclusion:
Rumination disorder is a psychological disorder. It is a rare behavioral problem often noticed in people of all ages. Rumination disorder presents itself with a variety of signs and symptoms. The exact cause behind it is still unknown, but studies and research have shown a correlation between certain causes and the presence of this disorder. A cardinal sign of this disorder is regurgitated food that does not taste bad or acidic. Often this disorder is confused with other gastroesophageal disorders or digestive failure disorders. Due to chronic regurgitation, this disorder is regarded or blown away as nausea or vomiting, which often leads to the wrong diagnosis.
Proper diagnosis and treatment are a must because if left untreated, rumination disorder may lead to definite complications which can be fatal. Rumination disorder is a chronic yet treatable disease.
