Rumination Disorder

Rumination disorder, classified in DSM-5 within Feeding and Eating Disorders, involves the repeated regurgitation of food, occurring at least once per week for at least one month, with subsequent rechewing, reswallowing, or spitting out of the regurgitated material. Unlike vomiting, rumination is effortless, painless, and lacks preceding nausea or retching. Episodes typically begin within 30 minutes after meals and may continue for 1-2 hours. The condition affects infants (usually appearing at 3-12 months), children with intellectual disability, and increasingly recognized in adults including adolescents and those with eating disorders.

Pathogenesis involves elevated intra-gastric pressure during postprandial period, relaxation of lower esophageal sphincter, voluntary or unconscious learned behavior pattern, and possible association with high-resolution manometry findings of esophagogastric junction relaxation timing abnormalities. In infants, it may relate to insufficient stimulation or mother-infant attachment problems, in those with developmental disabilities to self-stimulation, and in adults often follows stressful events or develops as conditioned response to gastrointestinal symptoms.

Diagnosis requires ROME IV criteria fulfillment: persistent or recurrent regurgitation of recently ingested food into the mouth with subsequent spitting or remastication and reswallowing, regurgitation not preceded by retching, and exclusion of other gastrointestinal disorders. Diagnostic workup excludes gastroesophageal reflux disease, achalasia, gastroparesis, eosinophilic esophagitis, and other organic causes through endoscopy, gastric emptying studies, esophageal manometry, and pH-impedance studies. Treatment focuses on diaphragmatic breathing as first-line intervention (proven highly effective), behavioral therapy, biofeedback, cognitive behavioral therapy for adults, and parental counseling for infants. Pharmacologic therapy with baclofen has shown some efficacy in refractory cases.