Review article: pathophysiology, differential diagnosis and management of rumination syndrome

Kathleen Blondeau (1) , Veerle Boecxstaens (2) , Nathalie Rommel (2) , Jan Tack (3)

1 Lab G-I Physiopathology
2 Center for Gastroenterological Research
3 Center for Gastroenterological Research

Background: Rumination syndrome, characterized by the effortless, often repetitive, regurgitation of recently ingested food into the mouth, was originally described in children and in the developmentally disabled. It is now well-recognized that rumination syndrome occurs in patients of all ages and cognitive abilities. Aim: To provide a scholarly review on our current understanding of the rumination syndrome. Methods: The review was conducted on the basis of a medline search to identify relevant publications pertaining to the pathophysiology, clinical diagnosis and management of rumination syndrome. Results: The Rome III consensus established diagnostic criteria for rumination syndrome in adults, children and infants. A typical history can be highly suggestive but esophageal (high resolution) manometry/impedance with ingestion of a meal may help to distinguish rumination syndrome from other belching/regurgitation disorders. The pathophysiology is incompletely understood, but involves a rise in intra-gastric pressure, generated by a voluntary, but often unintentional, contraction of the abdominal wall musculature, at a time of low pressure in the lower esophageal sphincter, causing retrograde movement of gastric contents into the esophagus. To date, controlled trials in the treatment rumination syndrome are lacking. The mainstay of treatment for rumination syndrome is explanation and behavioral treatment which consists of habit reversal techniques that compete with the urge to regurgitate. Chewing gum, prokinetics, baclofen and even anti-reflux surgery have been proposed as adjunctive therapies, but high quality studies are generally lacking. Conclusion: The rumination is an under-recognized condition with incompletely understood pathophysiology. Behavioral therapy seems effective, but controlled treatment trials are lacking.

Mots clés: Medicine

Kathleen Blondeau, Veerle Boecxstaens, Nathalie Rommel, Jan Tack. Review article: pathophysiology, differential diagnosis and management of rumination syndrome. Alimentary Pharmacology and Therapeutics, 2011, 33 (7), pp.782. ⟨10.1111/j.1365-2036.2011.04584.x⟩. ⟨hal-00613928⟩