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Park: Rumination
Special Review
Diagnosis and Treatment of Intractable Digestive Symptoms

The Korean Journal of Gastroenterology 2017; 70(6): 278-282.

Published online: 22 December 2017

DOI: https://doi.org/10.4166/kjg.2017.70.6.278

Rumination

Moo In Park

Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea.

Correspondence to: Moo In Park, Department of Internal Medicine, Kosin University College of Medicine, 262 Gamcheon-ro, Seo-gu, Busan 49267, Korea. Tel: +82-51-990-6719, Fax: +82-51-990-5055, mipark@ns.kosinmed.or.kr

Received 13 November 2017       Revised 11 December 2017       Accepted 11 December 2017

Copyright © 2017. Korean Society of Gastroenterology

Korean Society of Gastroenterology

(open-access):

This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Rumination syndrome is one of the functional gastroduodenal disorders. Effortless and repetitive regurgitation of recently ingested food from the stomach to the oral cavity followed by rechewing and reswallowing or spitting are the characteristic clinical features. This disorder is believed to be uncommon, but many patients with this disorder are overlooked by their physicians. Rumination might be caused by a reversal of the gastric contents through the esophagogastric junction, which is initiated by an increase in intragastric pressure. The characteristic symptoms are sufficient for the diagnosis of rumination syndrome. Postprandial high resolution esophageal impedance manometry can detect gastric pressurization exceeding 30 mmHg associated with the return of ingested material into the proximal esophagus, which is a pathognomonic finding of rumination syndrome. An extensive explanation of the condition and the underlying mechanism is the first step of the treatment of rumination syndrome. Behavioral therapy through diaphragmatic breathing is the mainstay of treatment. Further studies on the long term effects of biofeedback therapy as well as a proper strategy for refractory rumination syndrome are needed.

Keywords: Rumination, Regurgitation, Diaphragmatic breathing, Biofeedback

Figures and Tables

Fig. 1

High resolution esophageal impedance manometry showing two rumination episodes as an increase in the intragastric pressure associated with retrograde intra-esophageal flow on an impedance color plot. EGJ, esophagogastric junction; UES,upper esophageal sphincter; Adapted from the article of Lee TH.9

kjg-70-278-g001
Table 1

Effect of Diaphragmatic Breathing on the Symptoms of Rumination Syndrome

kjg-70-278-i001

NA, Not available; EMG, electromyography; CI, confidence interval.

Notes

Financial support None.

Conflict of interest None.

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