Rumination Syndrome

Rumination syndrome is a disorder in which patients involuntarily and effortlessly regurgitate and re-swallow gastric content during, and after, a meal. It is commonly confused with gastroesophageal reflux disease and may be errantly treated with proton pump inhibitors and even fundoplication. The pathophysiology appears to involve generation of high gastric pressures, perhaps from high intra-abdominal pressures, in the presence of reduced lower and upper esophageal sphincter pressures. This reversal of the normal pressure gradient facilitates retrograde propulsion of gastric content into the mouth. Although generally clinically defined, high-resolution esophageal manometry can be used to document these findings and prove the diagnosis if needed. Therapy relies on reversing these pressure phenomena, via diaphragmatic breathing, or using baclofen to increase LES pressure.