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Rumination Syndrome

Rumination syndrome is a disorder of the way in which the upper stomach and lower oesophagus behave in response to a meal. It is thought that the upper stomach relaxes to accommodate a meal, as it does in normal patients, but that instead of gradually moving through the stomach the lower oesophageal sphincter relaxes and simultaneously there is contraction of the abdominal wall musculature, forcing the meal in the upper stomach (fundus) across the open oesophageal sphincter and up into the throat or mouth.

It is a condition which like many other functional disorders appears to be related to psychological trauma although it is also recognised to happen in people who have trained themselves to relax the lower oesophageal sphincter, such as sword swallowers and patients who have taught themselves to vomit.

It is characterised by effortless vomiting of small or large amounts of food soon after ingestion of a meal. Typically it may arise within minutes of eating and may persist for upto 60 to 90 minutes.  The food is usually relatively undigested and tastes “as it went down”.  Rumination usually ceases once the regurgitate becomes acidic.

There is no effective medication although cognitive behaviour therapy (CBT) and diaphragmatic breathing are thought to be of benefit.

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