Rumination syndrome: a gut-brain disconnection that causes regurgitation

From stomach viruses and gastrointestinal issues to cancer, vomiting can be a common side effect of many illnesses. However, some people experience frequent regurgitation without really knowing the underlying cause. Recent research from Massachusetts General Hospital (MGH) sheds light on rumination syndrome, the root cause of some gastrointestinal illnesses, which may help certain individuals finally receive treatment for their symptoms.

Often misdiagnosed, rumination syndrome stems from a disconnection between the gut microbiome and the brain. Classified as a behavior disorder, it is brought about by habitual regurgitation that becomes uncontrollable after a prolonged period of time. Individuals report feeling discomfort after eating which usually results in the muscles of the abdomen pushing up the partially digested food.

According to scientists, the discomfort stems from the feeling of food sitting in the stomach, almost as if individuals have eaten too much food and cannot digest the food properly. This causes bodily stress that is mitigated by the regurgitation of the food. “This condition causes a lot of embarrassment and may stop people from eating with others,” says co-lead author Dr. Trisha Satya Pasricha, of MGH’s Division of Gastroenterology, in a statement. “It is not well understood, and is often mistaken for other disorders.”

Most gastrointestinal illnesses have comparable symptoms, such as nausea, vomiting, upset stomach, and even abdominal pain. Furthermore, similar diseases, such as gastroparesis, make it difficult to diagnose the syndrome. Both gastroparesis and rumination syndrome may be explained as feeling full while only having eaten a tiny portion of food. With an incorrect diagnosis, proper treatment cannot be given, causing individuals to avoid social events, and, in some cases, emaciation.

Pasricha and the research team, including Helen Burton Murray Ph.D. also from MGH, assessed 242 individuals who were experiencing nausea, vomiting, abdominal pain and, even symptoms of gastroparesis. Each individual had been checked by gastroenterologists for rumination syndrome, however, the research team was able to narrow down the diagnosis using a specialized system to gauge gastrointestinal symptoms.

Nearly 13% of the study group were assessed to have rumination syndrome, according to the gauging system. Moreover, nearly 50% of those individuals had difficulty interacting socially due to the symptoms.

There were no discrepancies between genders, ethnic groups, or prevalence of gastroparesis or diabetes. “There is little demographically that distinguishes these patients other than their tendency to regurgitate when eating,” said Pasricha. “They are not more likely to have a history of an eating disorder or weight problems.”

The team also noticed that those who fit the criteria for rumination syndrome were more likely to suffer from heartburn, especially during the day. Taking this into account, along with symptoms of frequent vomiting, specialists may be able to properly diagnose more individuals with this syndrome.

According to experts, treatment for this syndrome includes physical therapy of the diaphragm, which occurs via deep breaths in and out to practice voluntary regulation of the muscle. Previous studies with this therapy reveal positive results, especially for gastroesophageal reflux disease or GERD. Additionally, given that rumination syndrome is a behavior disorder, experts advise patients to incorporate cognitive behavioral therapy into their treatment plan. Referred to as CBT, this therapy focuses on helping the individual form new, healthier habits to improve their overall quality of life.

This study is published in Neurogastroenterology & Motility.

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