Common Indicators Of Rumination Syndrome

Rumination syndrome is a functional gastroduodenal disorder characterized by an individual who inadvertently and repeatedly spits up or regurgitates partially digested food from the stomach. The patient chews it up again, and then they either spit it out or re-swallow it. The cause of rumination syndrome is not always clear, but an increase in pressure within the abdominal area is known to play a role. When an individual's rumination syndrome goes untreated, damage to the esophagus may occur. 

Rumination syndrome may be diagnosed with a physical exam, behavioral observation, or a high-resolution esophageal manometry and impedance measurement. Behavior therapy is often used to treat this disorder by teaching the patient to recognize when rumination happens and how to implement breathing exercises during those occurrences. Medications are also commonly used to treat problematic complications of rumination disorder such as esophageal damage. 

Bad Breath


Bad breath or halitosis is best described as when an individual's breath smells unpleasant or foul regularly. The regurgitation of food in rumination syndrome patients happens shortly after ingesting the food. This means the food has been chewed up and mixed with saliva containing an enzyme called amylase. As the food is swallowed, the enzymes in the saliva continue the digestion process until the food reaches the stomach. Stomach acids are then secreted in response to the expansion of the stomach wall. Before enough stomach acid is produced, the food stays within the range of plant enzyme breakdown. 

This range means the degree of digestion sustained depends on how many raw plant enzymes are present. Regardless, the regurgitated food will have been digested to some degree. Enzymes in the saliva, food, and stomach are still present in the partially digested food. When the food is re-chewed, these enzymes populate the mouth on the tongue, between the teeth, and in the throat. Because of frequent regurgitation, the oral cavity will always have more digestive components present than it should. This excess is what causes the rumination syndrome patient to have persistent bad breath.

Frequent Regurgitation


Regurgitation occurs when food comes up into the mouth from the stomach or esophagus without forceful abdominal muscle contractions or nausea. Rumination means regurgitation is frequently occurring with no apparent physical cause other than involuntary habit. This regurgitation in patients with rumination syndrome usually occurs between fifteen and thirty minutes after the ingestion of food and can be described as effortless. The food does not taste particularly sour to affected individuals.

The best explanation for this type of regurgitation is that voluntary but subconscious contractions of the abdominal wall cause an increased amount of pressure and simultaneous relaxation of the sphincter in the esophagus. After the food reaches the mouth again, the patient re-chews it, and they either swallow or spit it out. The circumstances of the individual at the time of the regurgitation usually influence the decision to either swallow or spit the regurgitant. Food does not regurgitate when a rumination syndrome patient is asleep. Individuals with this disorder also do not respond to treatments for gastroesophageal reflux disease.

Unexplained Weight Loss


Some individuals affected by rumination syndrome will experience unexplained weight loss. Several factors can contribute to this manifestation. When a patient regurgitates food back up to the mouth, they then make a conscious choice to re-swallow it or spit it out. An individual who does not frequent social outings or spends most of their time alone is more likely to spit out the regurgitant than they are to swallow it. When the food is not re-swallowed, the nutrients in the food never make it to the patient's small intestine where essential nutrients are absorbed. 

Lack of nutrients and a reduction in the number of calories consumed can result in the individual losing a significant amount of weight. In addition, patients who do spend a considerable amount of time around others may develop the habit of food avoidance in fear they may regurgitate in front of others. This avoidance results in less overall calorie intake, and they often burn off more calories than they consume. Rumination syndrome can also cause an individual to become depressed due to an inability to manage the disorder. One manifestation of depression is not eating food regularly.



A common symptom in regurgitation syndrome patients is frequent nausea. This type of nausea does not occur during episodes of regurgitation, and it is not the precipitator of such regurgitation. Many factors can explain the relation between frequent nausea and rumination syndrome. Because of the disorder, patients are unable to eat a healthy and regular diet. Often, individuals affected by rumination syndrome will be deficient in one or more essential nutrients. One or more of these deficiencies can result in a speed change of metabolic processes that can cause frequent stomach upset. 

For individuals who avoid eating because of rumination syndrome, excessive hunger may also be responsible for numerous episodes of nausea. The lack of regular food digestion and its timing can cause the patient to experience low blood glucose levels frequently. Nausea is a common symptom that occurs with hypoglycemia. This disorder can also trick the digestive system into thinking there are not enough enzymes present to digest food. The digestive system may produce an excessive amount of bile and gastric juices in response to this. Excess bile and stomach juices can result in frequent nausea.

Feeling Full


Many patients who have rumination syndrome may also exhibit frequent episodes of feeling full. An individual normally feels full because food is not moving along the digestive tract as it should be. Essentially, feeling full can merely mean the stomach is not emptying at the rate it should. Because individuals with rumination syndrome do not receive a proper amount of nutrients regularly, they often acquire one or more vitamin and mineral deficiencies. 

When there are deficiencies of specific vitamins or minerals vital to the processes of digesting and metabolizing food, the body will have trouble carrying out those functions. The process of digestion in the stomach and the small intestine slows down, and the patient will feel full longer than normal. The increased amount of abdominal pressure known to play a role in causing the regurgitation that occurs in rumination syndrome patients can also make an affected individual feel full often.


    Whitney Alexandra