Summary about Disease
Rumination disorder is an eating disorder characterized by the effortless, repetitive regurgitation of recently swallowed food from the stomach into the mouth, where it may be re-chewed, re-swallowed, or spit out. It's not caused by nausea, retching, or disgust, and it differs from vomiting or GERD (gastroesophageal reflux disease). Individuals with rumination disorder don't typically exhibit weight loss or other signs of malnutrition, although this can occur.
Symptoms
Effortless regurgitation of food, usually within 30 minutes of eating
Re-chewing and re-swallowing or spitting out of regurgitated food
Lack of nausea or retching associated with regurgitation
Weight loss (in some cases, especially if the person avoids eating to prevent regurgitation)
Stomachache or indigestion
Bad breath
Tooth decay
Lip chapping
Causes
The exact cause of rumination disorder is not fully understood. In infants, it may be a learned behavior or a result of overstimulation, stress, or improper feeding techniques. In older children and adults, it may be associated with:
Stress
Anxiety
History of trauma or abuse
Intellectual disability or developmental delays
Social isolation
Other mental health conditions
Medicine Used
There is no specific medication specifically approved for rumination disorder. However, medications may be used to manage associated symptoms or underlying conditions:
Proton Pump Inhibitors (PPIs): To reduce stomach acid if GERD is suspected to be contributing to the problem.
Anti-anxiety medications or antidepressants: If anxiety or depression are identified as contributing factors.
Baclofen: A muscle relaxant that can sometimes reduce regurgitation.
Is Communicable
No, rumination disorder is not communicable. It is not an infectious disease and cannot be spread from person to person.
Precautions
Behavioral therapy: Is the main precaution to manage rumination.
Avoid Overeating: Eating smaller, more frequent meals may help.
Manage Stress: Techniques such as meditation, yoga, or deep breathing exercises can be beneficial.
Proper Feeding Techniques (for infants): Ensure proper positioning during feeding and avoid overfeeding.
Address Underlying Conditions: Treat any underlying anxiety, depression, or other mental health issues.
Dental Hygiene: Due to exposure of stomach acids, taking care of teeth is important.
How long does an outbreak last?
The duration of rumination disorder varies. It can be a chronic condition that persists for months or years if left untreated. With appropriate intervention, such as behavioral therapy, it may be managed effectively, and the episodes of regurgitation can be reduced or eliminated. In infants, it may resolve spontaneously as they develop.
How is it diagnosed?
Diagnosis typically involves:
Clinical Evaluation: A thorough medical history and physical examination.
Observation: Witnessing the behavior of regurgitation and re-swallowing or spitting out food.
Ruling Out Other Conditions: Excluding other gastrointestinal disorders, such as GERD, gastroparesis, or structural abnormalities.
Diagnostic Criteria: Using the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th Edition) criteria, which include the repeated regurgitation of food for at least one month.
Timeline of Symptoms
The timeline of symptoms can vary. However, a general progression might look like this:
Initial Onset: May begin suddenly or gradually.
Frequency: Regurgitation episodes may occur multiple times per day, often shortly after meals.
Progression: If untreated, the behavior may become more habitual and difficult to control.
Long-Term: Chronic rumination disorder can lead to complications such as weight loss, malnutrition, or dental problems.
Fluctuations: Symptoms may wax and wane depending on stress levels, anxiety, or other triggers.
Important Considerations
Differential Diagnosis: Rule out other medical conditions that can cause regurgitation.
Comorbidity: Be aware of co-occurring mental health conditions, such as anxiety or depression.
Behavioral Therapy: Is the treatment of choice, especially diaphragmatic breathing and habit reversal.
Nutritional Status: Monitor for weight loss or malnutrition, especially in chronic cases.
Dental Health: Advise on proper dental hygiene to prevent tooth decay.
Psychological Impact: Address any social or emotional distress caused by the condition.
Family Education: Educate families about the disorder and how to support the individual.