Rumination disorder

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mark Warren, M.D., M.P.H.; Fellow, Academy of Eating Disorders [2]; Kiran Singh, M.D. [3]

Synonyms and keywords: Childhood rumination disorder; merycism, rumination syndrome

Overview

Rumination is an eating disorder characterized by having the contents of the stomach drawn back up into the mouth, chewed for a second time, and swallowed again. In some animals, known as ruminants, this is a natural and healthy part of digestion and is not considered an eating disorder. However, in other species (including humans), such behavior is atypical and potentially dangerous as the esophagus can be damaged by frequent exposure to stomach acids. Rumination is also associated with eating disorders such as anorexia nervosa, and can be the result of one's apprehension and nervousness after eating a normal meal. For those with purging behaviors, rumination can take place when the option of getting rid of a meal via throwing up is not available (thus, one might feel worried and visibly upset). Rumination has also been reported in developmentally normal children and adults who experience regurgitation of previously swallowed food, without disgust, nausea or an acidic taste. The food is either chewed and reswallowed or spat out. Remission of these episodes is seen in some cases while others persist. Many claim this as a pleasurable habit.

Differential Diagnosis

• Anorexia nervosa
• Bulimia nervosa
• Gastroesophageal reflux
• Gastroparesis
• Hiatal hernia
• Pyloric stenosis
• Sandifer syndrome
• Vomiting

Epidemiology and Demographics

Prevalence

• The prevalence of rumination syndrome is higher among subjects with intellectual disability compared to the overall population.

Risk Factors

• Lack of stimulation
• Neglect
• Problems in the parent-child relationship
• Stressful life situations

Natural History, Complications and Prognosis

Rumination disorder typically occurs within the first 3-12 months of age and can lead to the child becoming malnourished.

While rumination disorder may begin in childhood or infancy, adults may also have this chronic disorder, for which there is presently no known cure nor cause. While those diagnosed with this condition in childhood may 'grow out of it', it is by no means a medical fact that they are bound to do so by adolescence or adulthood.

Remission of these episodes is seen in some cases while others persist.

Diagnostic Criteria

DSM-V Diagnostic Criteria for Rumination Disorder

“

A. Repeated regurgitation of food over a period of at least 1 month. Regurgitated food may be re-chewed, re-swallowed, or spit out. AND B. The repeated regurgitation is not attributable to an associated gastrointestinal or other medical condition (e.g., gastroesophageal reflux, pyloric stenosis). AND C. The eating disturbance does not occur exclusively during the course of anorexia nervosa,bulimia nervosa, binge-eating disorder, or avoidant/restrictive food intake disorder. AND D. If the symptoms occur in the context of another mental disorder (e.g., intellectual disability, Intellectual developmental disorder or another neuro developmental disorder),they are sufficiently severe to warrant additional clinical attention. Specify if: In remission: After full criteria for rumination disorder were previously met, the criteria have not been met for a sustained period of time.

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