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Rumination Syndrome

Rumination syndrome, also called Merycism, is a type of eating disorder not otherwise specified that causes the regurgitation of food. Even though it is not identified as a specific eating disorder in the DSM-IV, certain parameters have been outlined for diagnosing the disorder. If you have rumination syndrome, you may vomit immediately or shortly after eating. The vomiting occurs with ease and without any of the normal discomfort that is associated with vomiting such as gagging or nausea. Furthermore, the regurgitated food does not have the bile taste normally associated with regurgitation. After regurgitation, you may re-chew the regurgitated food or may dispose of it. Regurgitation after eating must occur for a minimum of two months for it to be considered an eating disorder. When you have rumination syndrome, the regurgitation occurs without intention and you have difficulty controlling the regurgitation.

Characteristics of Rumination Syndrome:

The primary sign of rumination syndrome is regurgitation following meals. The regurgitation can vary greatly as to how long after eating it occurs and how much is regurgitated. You may regurgitate small amounts immediately after eating or you may regurgitate large amounts and continue the regurgitation for hours after consuming the food. After regurgitation, you may re-chew the regurgitated food or may dispose of it by spitting it out. If you have rumination syndrome, your regurgitation of food occurs without any effort.

Your symptoms may intensify after consuming a large quantity of food or drink. In addition, you may experience more severe symptoms if you rapidly consume your food. Rumination syndrome can persist even if you only consume small amounts of food. Furthermore, it is not influenced by how well you chew your food before swallowing.

As a result of the regurgitation, rumination syndrome can produce symptoms like weight loss, infrequent bowel movements, constipation, diarrhea, nausea, nutritional deficiencies and/or tooth decay and erosion.

What Causes Rumination Syndrome?

Rumination Syndrome Treatment

There is treatment to help treat rumination syndrome.

The exact cause of rumination syndrome is unknown at this time. Some experts believe that the regurgitation in this disorder begins as a voluntary act (such as with bulimia nervosa) and then turns into an involuntary act. However, there are numerous cases of rumination syndrome that dispute this belief. Studies show this disorder can occur in people with no history of regurgitation.

Rumination syndrome may be caused by anatomical and structural defects. Deceased people with rumination syndrome where found to have antrum cardiacum, a condition that occurs when the lower part of your stomach is dilated.

Prevalence of Rumination Syndrome:

It is difficult to obtain statistical information concerning the prevalence of rumination syndrome for two main reasons. Firstly, rumination syndrome in adults is often not brought to the attention of health professionals because people afflicted are ashamed about their habits. Secondly, when rumination syndrome is brought to the attention of professionals, it is often misdiagnosed as a gastrointestinal problem or bulimia.

In the past, it was believed that this illness only existed in young children and mentally handicapped adults. Approximately 10% of infants and 10% of institutionalized adults may suffer from this syndrome. Although the exact prevalence rate is unclear, it is evident that this eating disorder occurs in the adult population.

The average age of onset for rumination syndrome is between 10 and 20 years old. Studies show that rumination syndrome is more prevalent in men than in women though this discrepancy could be because men are more likely to seek treatment.

Treatment for Rumination Syndrome:

Rumination syndrome is believed to be a physiological rather than psychological eating disorder. Treatments for controlling rumination syndrome are not usually effective. At this time no medications have proven successful in treating rumination syndrome. In addition, none of the standard medications for gastrointestinal disorders have shown effective for treating rumination syndrome. Some people with rumination syndrome can block regurgitation from occurring by smoking immediately after eating. If you have this syndrome, it is recommended that you adequately chew you food before swallowing, avoid certain foods, eat slowly and avoid drinking with meals.

Other treatments for rumination syndrome include: behavioral therapy techniques for preventing regurgitation, breathing exercises after eating, pressing on your throat when symptoms occur and/or stress management techniques. Hospitalization may be required for severe cases of rumination syndrome.

References:

American Psychiatric Association. (2001). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, D.C.

Brockbank, E. M. (1907). Merycism or rumination in man.  The British Medical Journal.

Chial, H. J., Camilleri, M., Williams, D. E., Litzinger, K & Perrault, J. (2003). Rumination syndrome in children and adolescents: Diagnosis, treatment and prognosis. Pediatrics.

Papadopoulos, V. & Mimidis, K. (2007). The rumination syndrome in adults: A review of the pathophysiology, diagnosis and treatment. Journal of Postgrad Medicine. Retrieved from http://www.jpgmonline.com/text.asp?2007/53/3/203/33868

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