The Esophagus: Rumination Syndrome

Rumination syndrome is one of the most misunderstood diagnoses in gastroenterology. It is commonly confused with and treated as gastroesophageal reflux, refractory vomiting, achalasia, or gastroparesis. Rumination syndrome has a clear pathophysiology that must be understood to provide an adequate treatment response. The most evident is gastroesophageal reflux disease (GERD). In severe GERD manifested by sustained and marked incompetence of the lower esophageal sphincter with or without a hiatal hernia, volumetric reflux of gastric content may occur. In most patients, the diagnosis of rumination syndrome is made by satisfying Rome criteria and taking a careful history. The most commonly used and effective therapy for rumination syndrome is diaphragmatic breathing performed postprandially. Psychologic and biofeedback therapies have historically been an important part of therapy for rumination syndrome based on its putative association with eating disorders and depression. The performance of fundoplication in rumination syndrome appears to be contraindicated.