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Current Diagnosis and Management of the Rumination Syndrome

Kessing, Boudewijn F. MD; Smout, André J.P.M. MD, PhD; Bredenoord, Albert J. MD, PhD

Journal of Clinical Gastroenterology: July 2014 - Volume 48 - Issue 6 - p 478–483
doi: 10.1097/MCG.0000000000000142
Clinical Reviews

The rumination syndrome is a behavioral condition characterized by postprandial regurgitation. In contrast to what many think, the disorder does not exclusively occur in mentally disabled patients or children but also in otherwise healthy adults. As symptoms of postprandial regurgitation are often mistaken for gastroesophageal reflux disease or vomiting, the rumination syndrome is an underappreciated condition. Rumination episodes are caused by an intragastric pressure increases which forces the gastric content into the esophagus and mouth and occurs during 3 distinct mechanisms: primary rumination, secondary rumination, and supragastric belch-associated rumination. Combined manometry-impedance can distinguish rumination from gastroesophageal reflux disease. Treatment of the rumination syndrome consists of a thorough explanation of the mechanisms underlying the rumination episodes and behavioral therapy. As behavioral therapy is a time-consuming and often expensive treatment, we propose that a clinical suspicion of the disorder is always confirmed by a manometry-impedance measurement.

Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands

B.F.K.: drafting of the manuscript, and approval of final submitted draft; A.J.B. and A.J.P.M.S.: critical revision of the manuscript for important intellectual content and approval of final submitted draft.

A.J.B. is supported by The Netherlands Organization for Scientific Research (NWO).

A.J.B. has been a consultant and honoraria recipient for AstraZeneca, has received grant funding from Shire, and payment for development of educational presentations from MMS International. The remaining authors declare that they have nothing to disclose.

Reprints: Albert J. Bredenoord, MD, PhD, Department of Gastroenterology and Hepatology, Academic Medical Center Amsterdam, Meibergdreef 9, Amsterdam 1105 AZ, The Netherlands (e-mail:

© 2014 by Lippincott Williams & Wilkins