Rumination Syndrome

What is rumination syndrome? It’s a functional gastrointestinal disorder that occurs when food that is swallowed – but not yet digested – gets regurgitated and comes back up from the stomach, through the esophagus and into the mouth. Children with rumination syndrome will either have to re-chew and re-swallow the undigested food or spit it out. Rumination syndrome, sometimes called rumination disorder, is a reflex, not a purposeful behavior and stems from errors in the way the brain and digestive system interact.


Rumination Syndrome

Care giver: Hi there. This video is about rumination syndrome. Rumination syndrome is a functional gastrointestinal disorder. This video will teach you about what rumination syndrome is and how we treat it at CHOP.

Normal digestion requires constant communication between your brain and your digestive system. Your brain talks to your digestive system to keep it working smoothly, and your digestive system talks to your brain about how that process is going.

Rumination and other functional GI disorders happen because of disruptions or changes to how this brain-gut communication is working. For this reason, functional GI disorders are also called disorders of gut-brain interaction. When someone has a functional GI disorder like rumination, their symptoms are not caused by inflammation, disease, or damage to the GI tract itself.

Instead, their symptoms are caused by how the brain and the gut are communicating.

Patient: What exactly is rumination?

Care giver: Rumination is the effortless and repeated regurgitation of food into your mouth.

Patient: Regurgitation -- is that like throwing up?

Care giver: Regurgitation means something swallowed comes up into the mouth again. However, regurgitation is not as forceful as vomiting. Instead, it feels effortless as though food comes up on its own.

Patient: Even though it's supposed to be effortless, sometimes I can tell I'm about to ruminate. Is that normal?

Care giver: Some people get a feeling, sensation or urge right before they ruminate. Common examples are pressure, pain, or the feeling of needing to burp. Usually this discomfort goes away or feels better right after ruminating.

Patient: When does rumination happen?

Care giver: It may happen during a meal or soon after you're done eating or drinking.

For most kids and teens, rumination happens many times during the day, and it might happen every time they eat or drink.

Patient: How does rumination work in the body?

Care giver: When you eat or drink, food or liquid travels from your mouth down your esophagus, and into your stomach. When food or liquids enter the stomach, your stomach might sense this as uncomfortable. In response to that discomfort, the abdominal muscles contract, the muscles squeeze or place pressure on the stomach. At the same time, a small trap door at the bottom of the esophagus, called a sphincter, relaxes. This allows the food or liquids to easily travel back up into the esophagus. If the abdominal muscles squeeze hard enough, the food or liquids will come all the way back into your mouth.

Patient: Why did rumination even start and why does it keep happening?

Care giver: Sometimes rumination can start after an illness or GI bug, and other times it might start when there is a change or stressor in your life. Rumination can also more easily occur for people who have other GI symptoms, such as reflux. For many children and teens, there is no specific trigger or cause.

Because rumination is a functional GI disorder, we know that rumination results from complex signals back and forth between the brain and the gut. No matter whether those signals started in the gut or the brain, the body seems to get stuck in a pattern so that rumination becomes a reflex or habit. Over time, this pattern becomes an automatic habit in response to eating or drinking.

It's like your digestive system learned to get rid of what you ate or drank instead of keeping it down. Even though rumination and the brain-gut communication that causes it, happens automatically, there are some things you can do to help your body unlearn this habit.

Topics Covered: Rumination Syndrome

Related Centers and Programs: Suzi and Scott Lustgarten Center for GI Motility