Materiały źródłowe

• #1 Rumination Disorder – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK576404/

  The initial management of patients with rumination syndrome consists of education regarding the disease process, reassurance, and behavioral modifications to reduce the episodes of regurgitation. […] Diaphragmatic breathing is the first-line treatment for rumination syndrome. It works by initiating a competing mechanism to the acquired, unperceived contractions of the abdominothoracic muscles. The patient is instructed to sit in a chair and place one hand on the chest and the other on the abdomen. During breathing, only the hand on the abdomen is allowed to move with slow and deep 6 to 8 respirations per minute. The patients inhale, contracting the diaphragm and expanding the abdomen. […] Diaphragmatic breathing should be initiated after completion of a meal or with signs of incoming regurgitations. Effects of diaphragmatic breathing can be visualized via EMG and/or HRIM (biofeedback), which helps some patients to objectify the method. Referral to a behavioral therapist for augmentation strategies (general relaxation and gum chewing) and cognitive behavioral therapy for rumination disorder (CBT-RD) can be used as adjuncts.

• #2 Rumination syndrome: pathophysiology, diagnosis and practical management

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9380772/

  Rumination syndrome should be considered in any patient who presents with recurrent regurgitation without associated retching or significant nausea. […] Behavioural therapies including diaphragmatic breathing and biofeedback are effective treatments for rumination syndrome and have the largest evidence bases. […] Following treatment, most patients have large reductions in their frequency of regurgitation. […] Behavioural interventions have the greatest evidence base for the treatment of rumination syndrome. The two interventions most often used are diaphragmatic breathing and biofeedback. […] Diaphragmatic breathing has been shown to significantly reduce the frequency of regurgitation, increase the pressure at the oesophagogastric junction and reduce intragastric pressure. […] When the response to diaphragmatic breathing is incomplete, more advanced behavioural therapy with biofeedback may be an effective tool for rumination syndrome.

• #3 Rumination Disorder – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK576404/

  Limited data is available concerning medical therapy for rumination syndrome. Generally, pharmacotherapy for rumination syndrome should be reserved for patients who fail initial management with behavioral therapy. Pauwels et al. indicated in a small cross-over study that baclofen 10 mg three times a day reduces flow events and improves patient-reported symptoms in rumination syndrome, with similar results reported in different studies. […] Baclofen counteracts transient lower esophageal sphincter (LES) relaxations by increasing the basal LES pressure, thereby limiting regurgitation episodes. […] Rumination syndrome is considered an acquired habit and is therefore reversible. Diaphragmatic breathing proved in multiple studies to be of benefit by decreasing regurgitations. Additionally, pharmacologic (baclofen, buspirone) and non-pharmacologic treatment modalities (CBT, chewing gum, general relaxation) are available.

• #4 Rumination syndrome: pathophysiology, diagnosis and practical management

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9380772/

  Rumination syndrome should be considered in any patient who presents with recurrent regurgitation without associated retching or significant nausea. […] Behavioural therapies including diaphragmatic breathing and biofeedback are effective treatments for rumination syndrome and have the largest evidence bases. […] Following treatment, most patients have large reductions in their frequency of regurgitation. […] Behavioural interventions have the greatest evidence base for the treatment of rumination syndrome. The two interventions most often used are diaphragmatic breathing and biofeedback. […] Diaphragmatic breathing has been shown to significantly reduce the frequency of regurgitation, increase the pressure at the oesophagogastric junction and reduce intragastric pressure. […] When the response to diaphragmatic breathing is incomplete, more advanced behavioural therapy with biofeedback may be an effective tool for rumination syndrome.

• #5 Rumination Disorder – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK576404/

  The initial management of patients with rumination syndrome consists of education regarding the disease process, reassurance, and behavioral modifications to reduce the episodes of regurgitation. […] Diaphragmatic breathing is the first-line treatment for rumination syndrome. It works by initiating a competing mechanism to the acquired, unperceived contractions of the abdominothoracic muscles. The patient is instructed to sit in a chair and place one hand on the chest and the other on the abdomen. During breathing, only the hand on the abdomen is allowed to move with slow and deep 6 to 8 respirations per minute. The patients inhale, contracting the diaphragm and expanding the abdomen. […] Diaphragmatic breathing should be initiated after completion of a meal or with signs of incoming regurgitations. Effects of diaphragmatic breathing can be visualized via EMG and/or HRIM (biofeedback), which helps some patients to objectify the method. Referral to a behavioral therapist for augmentation strategies (general relaxation and gum chewing) and cognitive behavioral therapy for rumination disorder (CBT-RD) can be used as adjuncts.

• #6 Rumination syndrome: pathophysiology, diagnosis and practical management | Frontline Gastroenterology

  https://fg.bmj.com/content/13/5/440

  Behavioural therapies including diaphragmatic breathing and biofeedback are effective treatments for rumination syndrome and have the largest evidence bases. […] Following treatment, most patients have large reductions in their frequency of regurgitation. […] Behavioural interventions have the greatest evidence base for the treatment of rumination syndrome. The two interventions most often used are diaphragmatic breathing and biofeedback. […] Diaphragmatic breathing has been shown to significantly reduce the frequency of regurgitation, increase the pressure at the oesophagogastric junction and reduce intragastric pressure. […] When the response to diaphragmatic breathing is incomplete, more advanced behavioural therapy with biofeedback may be an effective tool for rumination syndrome.

• #7 Rumination Syndrome: Causes, Signs & Symptoms, Treatment

  https://my.clevelandclinic.org/health/diseases/17981-rumination-syndrome

  The main treatment for rumination syndrome is behavioral therapy to stop regurgitation. […] The behavioral therapy that is usually prescribed for rumination syndrome is diaphragmatic breathing. […] To perform diaphragmatic breathing to help control regurgitation: […] Practice this exercise for 5 to 10 minutes, three to four times a day. You can increase the effort of the exercise by placing a book on your abdomen. Individuals can also practice belly breathing after each bite or meal, as needed.

• #8 Rumination Disorder: Treatment in Children vs. Adults, and More

  https://www.healthline.com/health/rumination-disorder

  Treatment for rumination disorder is the same in both children and adults. Treatment focuses on changing the learned behavior responsible for regurgitation. Different approaches may be used. Your doctor will tailor the approach based on your age and abilities. […] The simplest and most effective treatment for rumination disorder in children and adults is diaphragmatic breathing training. It involves learning how to breathe deeply and relax the diaphragm. Regurgitation cannot occur when the diaphragm is relaxed. […] Apply diaphragmatic breathing techniques during and right after meals. Eventually, rumination disorder should disappear. […] Other treatments for rumination disorder can include: changes in posture, both during and right after a meal, removing distractions during meal times, reducing stress and distractions during meal times, psychotherapy. […] There is currently no medication available for rumination disorder.

• #9 Rumination Disorder – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK576404/

  The initial management of patients with rumination syndrome consists of education regarding the disease process, reassurance, and behavioral modifications to reduce the episodes of regurgitation. […] Diaphragmatic breathing is the first-line treatment for rumination syndrome. It works by initiating a competing mechanism to the acquired, unperceived contractions of the abdominothoracic muscles. The patient is instructed to sit in a chair and place one hand on the chest and the other on the abdomen. During breathing, only the hand on the abdomen is allowed to move with slow and deep 6 to 8 respirations per minute. The patients inhale, contracting the diaphragm and expanding the abdomen. […] Diaphragmatic breathing should be initiated after completion of a meal or with signs of incoming regurgitations. Effects of diaphragmatic breathing can be visualized via EMG and/or HRIM (biofeedback), which helps some patients to objectify the method. Referral to a behavioral therapist for augmentation strategies (general relaxation and gum chewing) and cognitive behavioral therapy for rumination disorder (CBT-RD) can be used as adjuncts.

• #10 Biofeedback therapy reduces regurgitation episodes in rumination | Nature Reviews Gastroenterology & Hepatology

  https://www.nature.com/articles/nrgastro.2014.73

  Biofeedback-guided control of abdomino-thoracic muscular activity can help reduce the number of regurgitation episodes in patients with rumination syndrome, according to the findings of a recent study. […] Elizabeth Barba and colleagues decided to perform a prospective study to investigate whether rumination could be reduced by behavioural treatment.

• #11 Treatment Options For Rumination Disorder: Medications, Therapies, & More

  https://www.therecoveryvillage.com/mental-health/rumination-disorder/treatment/

  Diaphragmatic breathing is a technique used to treat rumination disorder. By using diaphragmatic breathing exercises, the person uses a relaxation technique to inhale and exhale by expanding the abdomen instead of the chest. This type of breathing is incompatible with regurgitation of food, meaning a person can’t engage in rumination behaviors while practicing this breathing. […] Currently, the most effective treatment strategies in rumination disorder consist of behavioral therapy focusing on breathing and relaxation techniques. Breathing techniques use habit reversal to create a competing behavior (or a distraction) to reduce the regurgitation episodes. […] Rumination disorder strategies must include education for both the parents and child, rebonding of the parent and child, counseling, support groups, stress reduction and treating underlying psychopathologies like depression or anxiety.

• #12 Frontiers | Rumination Syndrome in Children and Adolescents: A Mini Review

  https://www.frontiersin.org/journals/pediatrics/articles/10.3389/fped.2021.709326/full

  To the extent that stress is an exacerbating factor in rumination, diaphragmatic breathing also may provide indirect benefit by inducing a relaxation response that can further minimize the likelihood of rumination. Other commonly employed methods for addressing anxiety, such as cognitive behavioral therapy or hypnosis, are frequently utilized as part of multiple interventions in the treatment of rumination but have not been evaluated individually in controlled trials for the treatment of rumination. […] As noted earlier, in a prospective study of patients in a pediatric gastroenterology clinic, Malik and colleagues evaluated 50 children presenting with vomiting and diagnosed rumination syndrome in 30. Seven of these self-resolved without treatment after the initial consultation, counseling, and evaluation and 23 underwent education regarding the pathophysiology of rumination and were taught diaphragmatic breathing. Of these 23 patients, rumination resolved in 82.6% initially, although 28.5% of these relapsed. In a retrospective study of 52 children utilizing instruction in diaphragmatic breathing, biofeedback, relaxation training, and/or cognitive behavioral therapy, rumination resolved in 29.6%, improved in 55.6%, and was unchanged in 12.9%. In a group of 12 patients treated as inpatients with antidepressants, anxiolytics, and cognitive behavioral therapy with biofeedback or relaxation techniques, resolution or improvement was seen in 10 of 12 patients. In a long-term (9.5–48.5 months) follow-up study of patients treated for rumination, 40% reported a rumination-free period of 2 weeks–6 months and 19% a remission-free period of >6 months. However, over 70% of those with prolonged remission periods had recurrence, most often associated with stress, illness, specific foods, or menstruation—triggers also common for other FGIDs.

• #13 GiKids – Rumination Disorder

  https://gikids.org/digestive-topics/rumination-disorder/

  Treatment of rumination disorder occurs with coordinated care between a psychologist and pediatric gastroenterologist. The best strategies may depend on the child age, how the child gets nutrition (such as eating by mouth, or have a feeding tube), the childs stage of development, and whether the child has other gastrointestinal symptoms that may trigger rumination. When possible, treating the underlying trigger can help break the habit of rumination. […] For normally developing children who are at least school-aged, a common rumination treatment is diaphragmatic breathing. This strategy teaches the child to breathe from the abdomen and diaphragm instead of the chest. This treatment can help overcome the automatic muscle contraction and improve strength of the involved muscles. A psychologist or therapist can help a child learn and practice this breathing technique.

• #14 GiKids – Rumination Disorder

  https://gikids.org/digestive-topics/rumination-disorder/

  Some children can benefit from other treatment methods. Habit reversal treatment involves three main components: 1) increasing awareness of the urge to ruminate, 2) using a competing behavior to prevent or stop rumination, and 3) relaxation training. Some competing behaviors might be chewing gum or sucking on hard candy after meals. These competing behaviors involve repeated swallowing, which can interfere with the flow of stomach contents up the esophagus. Both strategies can help retrain the stomach to get used to normal pressure in the stomach until food begins to be digested (usually within 3060 minutes after meals). […] Consistently stopping regurgitation using deep breathing or another competing response, avoiding trigger foods, having good posture while eating, and re-swallowing the regurgitated contents when breakthrough occurs are also keys to effective treatment. Medications may be considered under the direction of your childs care providers and may involve protecting the esophagus, decreasing the feeling of pressure in the abdomen, and/or addressing any underlying trigger.

• #15 Rumination Disorder – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK576404/

  Limited data is available concerning medical therapy for rumination syndrome. Generally, pharmacotherapy for rumination syndrome should be reserved for patients who fail initial management with behavioral therapy. Pauwels et al. indicated in a small cross-over study that baclofen 10 mg three times a day reduces flow events and improves patient-reported symptoms in rumination syndrome, with similar results reported in different studies. […] Baclofen counteracts transient lower esophageal sphincter (LES) relaxations by increasing the basal LES pressure, thereby limiting regurgitation episodes. […] Rumination syndrome is considered an acquired habit and is therefore reversible. Diaphragmatic breathing proved in multiple studies to be of benefit by decreasing regurgitations. Additionally, pharmacologic (baclofen, buspirone) and non-pharmacologic treatment modalities (CBT, chewing gum, general relaxation) are available.

• #16 Rumination syndrome: pathophysiology, diagnosis and practical management | Frontline Gastroenterology

  https://fg.bmj.com/content/13/5/440

  Recent evidence suggests that diaphragmatic breathing and biofeedback are not only beneficial for treating primary rumination, but may also be effective in treating secondary rumination associated with acid reflux. […] Baclofen may however be a reasonable option as second-line management option following behavioural approaches. […] Limited evidence from case series suggests that in refractory cases, rumination syndrome can be treated with Nissens fundoplication in order to enhance the resting pressure of the LOS.

• #17 Rumination Disorder – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK576404/

  Limited data is available concerning medical therapy for rumination syndrome. Generally, pharmacotherapy for rumination syndrome should be reserved for patients who fail initial management with behavioral therapy. Pauwels et al. indicated in a small cross-over study that baclofen 10 mg three times a day reduces flow events and improves patient-reported symptoms in rumination syndrome, with similar results reported in different studies. […] Baclofen counteracts transient lower esophageal sphincter (LES) relaxations by increasing the basal LES pressure, thereby limiting regurgitation episodes. […] Rumination syndrome is considered an acquired habit and is therefore reversible. Diaphragmatic breathing proved in multiple studies to be of benefit by decreasing regurgitations. Additionally, pharmacologic (baclofen, buspirone) and non-pharmacologic treatment modalities (CBT, chewing gum, general relaxation) are available.

• #18 What Is Rumination Disorder? | Symptoms & Treatment

  https://withinhealth.com/learn/articles/rumination-disorder

  There are currently no FDA-approved medications to treat rumination disorder. However, Baclofen is a medication that has shown promise. It’s believed to reduce regurgitation following a meal by increasing the resting pressure of the esophagus, potentially reducing the relaxation that leads to effortless regurgitation. Currently, Baclofen is only prescribed in cases where patients don’t improve with behavioral interventions, due to its side effects, which include dizziness, weakness, constipation, and headaches.

• #19 Rumination Syndrome – Guts UK

  https://gutscharity.org.uk/advice-and-information/conditions/rumination-syndrome/

  WHAT TREATMENT IS AVAILABLE FOR RUMINATION SYNDROME? Treatment options available range from breathing exercises, which have the most evidence-base, and to a lesser extent medication. […] As Rumination Syndrome is an acquired behavioural disorder, behavioural modification to correct it is the main type of treatment for this condition with the most evidence-base in clinical trials. Diaphragmatic breathing is a technique taught to the patient which is thought to break the habit and retrain the muscles to compete with the urge to ruminate. […] Medications have a limited role in the treatment of Rumination Syndrome. […] Baclofen has been shown to reduce the relaxations of the lower gullet which occur during regurgitation. […] As rumination can begin with a stressful life event or occur alongside a mental illness, some patients have been offered mindfulness exercises to destress.

• #20 Treatment options for rumination syndrome: A systematic review

  https://www.wjgnet.com/2308-3840/full/v7/i6/297.htm

  The physiology tests also allow us to understand the rationale for these treatment options, especially in DB, where the evidence appears strongest in terms of quantity and quality. […] Since both DB and baclofen appear to be effective and work via different mechanisms, we postulate that a switching to the other therapy or a combination of these therapies could be useful in cases refractory to either treatments.

• #21 Rumination syndrome | UM Health-Sparrow

  https://www.uofmhealthsparrow.org/departments-conditions/conditions/rumination-syndrome

  For infants, treatment usually focuses on working with parents or caregivers to change the infant’s environment and behavior. […] Some people with rumination syndrome may benefit from treatment with medicine that helps relax the stomach after eating. […] If frequent rumination is damaging the esophagus, proton pump inhibitors such as esomeprazole (Nexium) or omeprazole (Prilosec) may be prescribed. These medicines can protect the lining of the esophagus until behavior therapy reduces the frequency and severity of regurgitation.

• #22 Rumination syndrome | Beacon Health System

  https://www.beaconhealthsystem.org/library/diseases-and-conditions/rumination-syndrome?content_id=CON-20377320

  Some people with rumination syndrome may benefit from treatment with medicine that helps relax the stomach after eating. […] If frequent rumination is damaging the esophagus, proton pump inhibitors such as esomeprazole (Nexium) or omeprazole (Prilosec) may be prescribed. These medicines can protect the lining of the esophagus until behavior therapy reduces the frequency and severity of regurgitation.

• #23 Rumination syndrome. A review article | Revista de Gastroenterología de México

  https://www.revistagastroenterologiamexico.org/en-rumination-syndrome-a-review-article-articulo-S2255534X21000311

  Tricyclic antidepressants, together with diaphragmatic breathing and audio relaxation techniques for at least 3 months, have also been used in patients with rumination syndrome. […] The most widely used tricyclic antidepressant in that study was nortriptyline, starting at a dose of 10mg at night, with a weekly increase of 10mg, until achieving symptom improvement, with a minimum of adverse effects. […] There is also a case report in the literature of a female patient with a history of regurgitation of recently ingested food, who had been diagnosed with a number of diseases (bile duct pathology, gastroparesis, among others). […] The post-Nissen adverse event of dysphagia was described in one of the 5 patients.

• #24 Rumination Syndrome: An Update on Diagnostic and Treatment Strategies – Practical Gastro

  https://practicalgastro.com/2016/09/02/rumination-syndrome-an-update-on-diagnostic-and-treatment-strategies/

  Proton pump inhibitors may be required for protection of the esophageal mucosa. Antiemetic medications such as ondansetron or promethazine are required for break- through symptoms. Tricyclic anti-depressants (TCA) play a role in decreasing gastric hypersensitivity, the sensation of fullness and abdominal muscle pain, in addition to decreasing gastric sensitivity. […] Nutritional support prevents the complications including dehydration, vitamin deficiencies and marked hypokalemia which may require frequent hospitalizations. In patients awaiting response to behavioral therapy, a temporary jejunostomy tube provides enteral nutrition while bypassing the stomach. […] The focus of treatment is using breathing and relaxation techniques to distract patients as they attempt to eat small meals. A close relationship between the doctor and the patient is paramount in the treatment of this disease and a mental health specialist may be required to maximize the relaxation training as well as address the underlying provocative event.

• #25 Multidisciplinary Treatment Is Effective for Patients With Rumination Syndrome – Pediatrics Nationwide

  https://pediatricsnationwide.org/2023/03/27/multidisciplinary-treatment-for-rumination-syndrome-associates-with-high-rates-of-symptom-improvement/

  RS is a disorder that cannot be effectively treated by a GI doctor alone. It really requires a multidisciplinary team. Treatment of RS involves a GI doctor and a GI psychologist, and we oftentimes will involve one of our GI dieticians or more team members as well. I think [RS management] is a good example of how we can adapt, from a medical standpoint, to better serve the patient. It’s just a good example of the importance of multidisciplinary care.

• #26 Rumination Disorder | Psychology Today

  https://www.psychologytoday.com/us/conditions/rumination-disorder

  Treatment for rumination disorder may involve working with gastroenterologists, general or nurse practitioners, and therapists. […] The primary treatment approach is diaphragmatic breathing, in which patients learn to breathe deeply from their diaphragm rather than their chest. This will help relax the diaphragm, adjust pressure in the esophagus, and consequently prevent regurgitations after eating. A therapist can help the patient learn this skill and integrate it into their mealtime routine.

• #27 Rumination Syndrome | Safe Harbor Treatment Center

  https://safeharbortreatmentcenter.com/what-we-treat/co-occurring-disorders/rumination-syndrome/

  Some patients with rumination syndrome also struggle with depression, anxiety, worry, and stress. These problems often occur as a result of having rumination syndrome but can also be part of the trigger. Struggling with these problems makes treating rumination syndrome more difficult, so it is important to implement a treatment plan that targets any co-occurring problems or disorders.

• #28 Treatment For Persistent Ruminating Thoughts: Therapy, Mindfulness, & More

  https://www.therecoveryvillage.com/mental-health/rumination/treatment/

  The best medications for managing rumination are those that treat an underlying mental health condition such as generalized anxiety disorder (GAD), depression, obsessive-compulsive disorder and post-traumatic stress disorder. […] SSRIs and SNRIs for depression have shown efficacy and would likely help severe rumination. Once major symptoms are under control, therapeutic methods like RFCBT may prove even more useful. […] The outlook for obsessive rumination is fair to good with interventions like CBT and RFCBT. Medications can be used as needed for underlying conditions such as anxiety or depression.

• #29 Rumination Syndrome Treatment | Nationwide Children’s

  https://www.nationwidechildrens.org/specialties/rumination-syndrome-program/rumination-syndrome-treatment

  If your child has been diagnosed with rumination syndrome and you would like to learn more about our treatment program, please follow the link below. […] There are three treatment programs depending on level of care. All programs start with an initial clinic visit with the physician and psychologist. […] The Intensive Outpatient Program involves three to five days of treatment that includes two to three meals per day. […] The General Outpatient Program includes single-treatment meals scheduled every two to four weeks based on patient need. This is typically reserved for local patients related to length of time for treatment. […] For the Inpatient Program, patients have two to three treatment meals per day for up to two weeks and remain in the hospital during this time. This is reserved for patients with the most severe form of rumination and includes additional therapies outside of meals.

• #30 Rumination Syndrome Program | Nationwide Children’s

  https://www.nationwidechildrens.org/specialties/rumination-syndrome-program

  Our Rumination Syndrome Treatment Program exists to provide treatment for patients with this condition, to increase awareness of rumination syndrome and to conduct clinical research to further its understanding and treatment. […] The Rumination Syndrome Treatment Program is leading the field of practice and research with patients with rumination syndrome. […] We have multiple levels of treatment, based on severity of symptoms, and patient age and needs. We have three levels of care, including: outpatient, intensive outpatient, inpatient treatment programs. […] Our program is unique in that our approach is multidisciplinary, addressing various aspects of patient care and tailoring treatment to each individual’s needs. […] Nationwide Children’s offers three treatment levels for children and teens with rumination syndrome.

• #31 Rumination Syndrome: An Update on Diagnostic and Treatment Strategies – Practical Gastro

  https://practicalgastro.com/2016/09/02/rumination-syndrome-an-update-on-diagnostic-and-treatment-strategies/

  Proton pump inhibitors may be required for protection of the esophageal mucosa. Antiemetic medications such as ondansetron or promethazine are required for break- through symptoms. Tricyclic anti-depressants (TCA) play a role in decreasing gastric hypersensitivity, the sensation of fullness and abdominal muscle pain, in addition to decreasing gastric sensitivity. […] Nutritional support prevents the complications including dehydration, vitamin deficiencies and marked hypokalemia which may require frequent hospitalizations. In patients awaiting response to behavioral therapy, a temporary jejunostomy tube provides enteral nutrition while bypassing the stomach. […] The focus of treatment is using breathing and relaxation techniques to distract patients as they attempt to eat small meals. A close relationship between the doctor and the patient is paramount in the treatment of this disease and a mental health specialist may be required to maximize the relaxation training as well as address the underlying provocative event.

• #32 Rumination Syndrome (for Parents) | Nemours KidsHealth

  https://kidshealth.org/en/parents/rumination-syndrome.html

  Treatment for rumination syndrome includes teaching kids the right way to eat food and let it digest. They learn how to notice when their belly gets tight and relax the muscles to help prevent food from coming back up. […] Your doctor may suggest seeing a mental health provider, such as a psychologist. They can help your child deal with anxiety or depression and teach behavioral techniques, including: […] Diaphragmatic breathing. Kids learn how to sense when food is going to come back up. […] Exposure therapy. Children gradually face situations that trigger rumination syndrome. […] If rumination syndrome causes your child to lose weight or not grow properly, your doctor may suggest diet changes. Sometimes kids need enteral (EN-tur-ul) nutrition therapy, which consists of special drinks with vitamins and other nutrients kids need to grow.

• #33 Rumination Syndrome – Guts UK

  https://gutscharity.org.uk/advice-and-information/conditions/rumination-syndrome/

  A Nissen Fundoplication surgery that adjusts abdominal pressure through wrapping the top part of the stomach around the oesophagus is one surgical treatment that has been tried, it is however rarely used and not supported by robust evidence. […] In the early stages after diagnosis, it is important that nutrition, oral intake and weight is monitored as well as hydration status.

• #34 Rumination syndrome: pathophysiology, diagnosis and practical management

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9380772/

  Baclofen may however be a reasonable option as second-line management option following behavioural approaches. […] Limited evidence from case series suggests that in refractory cases, rumination syndrome can be treated with Nissens fundoplication in order to enhance the resting pressure of the LOS and to partially negate the intragastric propulsive force provided by contraction of anterior wall musculature by reducing concurrent LOS relaxation.

• #35 Rumination syndrome: Critical review | Gastroenterología y Hepatología (English Edition)

  https://www.elsevier.es/es-revista-gastroenterologia-hepatologia-english-edition–382-articulo-rumination-syndrome-critical-review-S2444382422000189

  Due to the pathophysiological mechanism of rumination syndrome, drugs that improve gastric accommodation or emptying or that increase lower oesophageal sphincter tone may be helpful. […] Baclofen is a gamma-aminobutyric acid (GABA) receptor agonist that acts by increasing lower oesophageal sphincter tone and suppressing transient relaxation of that sphincter. […] A small case series reported resolution of symptoms in five patients with rumination syndrome refractory to medical treatment and behavioural therapy, who were treated by means of Nissen fundoplication. […] However, in view of the absence of high-quality information from randomised clinical studies, as well as the risks inherent to major surgery, surgical treatment is not included in the therapeutic algorithm for rumination syndrome, and its role should be limited to research.

• #36 Rumination Syndrome – About Kids GI

  https://aboutkidsgi.org/upper-gi/rumination-syndrome/

  The treatment of this condition involves behavioral modification. The current behavioral treatment for rumination syndrome consists of habit reversal using special breathing techniques (diaphragmatic breathing) to compete with the urge to regurgitate. Habit reversal techniques are used in such a way that the target behavior (rumination) is eliminated by the consistent use of an incompatible or competing behavior. The rumination behavior is eliminated because rumination and the competing response cannot be performed at the same time. […] In our experience, medications are not helpful at improving symptoms. Operations such as fundoplication [a surgical procedure in which the upper part of the stomach is wrapped around the lower esophagus] to inhibit regurgitation of stomach contents have not proven to be effective in the setting of rumination, and adults who received the operation had considerable upper abdominal discomfort after meals, though the regurgitation was stopped.

• #37 Rumination Disorder – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK576404/

  Limited data is available concerning medical therapy for rumination syndrome. Generally, pharmacotherapy for rumination syndrome should be reserved for patients who fail initial management with behavioral therapy. Pauwels et al. indicated in a small cross-over study that baclofen 10 mg three times a day reduces flow events and improves patient-reported symptoms in rumination syndrome, with similar results reported in different studies. […] Baclofen counteracts transient lower esophageal sphincter (LES) relaxations by increasing the basal LES pressure, thereby limiting regurgitation episodes. […] Rumination syndrome is considered an acquired habit and is therefore reversible. Diaphragmatic breathing proved in multiple studies to be of benefit by decreasing regurgitations. Additionally, pharmacologic (baclofen, buspirone) and non-pharmacologic treatment modalities (CBT, chewing gum, general relaxation) are available.

• #38 Rumination syndrome: pathophysiology, diagnosis and practical management | Frontline Gastroenterology

  https://fg.bmj.com/content/13/5/440

  Behavioural therapies including diaphragmatic breathing and biofeedback are effective treatments for rumination syndrome and have the largest evidence bases. […] Following treatment, most patients have large reductions in their frequency of regurgitation. […] Behavioural interventions have the greatest evidence base for the treatment of rumination syndrome. The two interventions most often used are diaphragmatic breathing and biofeedback. […] Diaphragmatic breathing has been shown to significantly reduce the frequency of regurgitation, increase the pressure at the oesophagogastric junction and reduce intragastric pressure. […] When the response to diaphragmatic breathing is incomplete, more advanced behavioural therapy with biofeedback may be an effective tool for rumination syndrome.

• #39 Rumination syndrome – Wikipedia

  https://en.wikipedia.org/wiki/Rumination_syndrome

  Diagnosis of rumination syndrome is non-invasive and based on a history of the individual. Treatment is promising, with upwards of 85% of individuals responding positively to treatment, including infants and mentally disabled people. […] Treatment is different for infants and mentally disabled adults than for adults and adolescents of typical intelligence. Among infants and mentally disabled adults, behavioral and mild aversion training has been shown to cause improvement in most cases. […] In patients of normal intelligence, rumination is not an intentional behavior and is habitually reversed using diaphragmatic breathing to counter the urge to regurgitate. Alongside reassurance, explanation and habit reversal, patients are shown how to breathe using their diaphragms prior to and during the normal rumination period. […] Supportive therapy and diaphragmatic breathing has shown to cause improvement in 56% of cases, and total cessation of symptoms in an additional 30% in one study of 54 adolescent patients who were followed up 10 months after initial treatments.

• #40 Rumination Syndrome Treatment | Nationwide Children’s

  https://www.nationwidechildrens.org/specialties/rumination-syndrome-program/rumination-syndrome-treatment

  Several studies of the treatment of rumination syndrome have produced some very positive and exciting findings. Research has highlighted many important parts of treatment. […] Families who take an active role in learning, understanding, and treating rumination have the best outcomes. […] Treating symptoms such as nausea or bloating that occur after eating can reduce the frequency of the rumination behavior. […] Treatment includes focusing on increasing awareness of what your abdominal muscles are doing, learning new behaviors for the abdominal muscles instead of tightening, and keeping the body relaxed during mealtimes. […] Patients benefit from starting very slowly with small amounts and then gradually increasing their stomachs ability to tolerate greater amounts of food and fluid.

• #41 Rumination Syndrome | Safe Harbor Treatment Center

  https://safeharbortreatmentcenter.com/what-we-treat/co-occurring-disorders/rumination-syndrome/

  It is very important that patients and their families understand the diagnosis, so they do not worry that it is another condition or disease. Families who participate in treatment see the best results. […] Symptoms such as nausea or bloating that occur after eating should be treated to try to reduce the frequency of regurgitation. […] Treatment should include learning about how habits are formed, learning about what your abdominal muscles are doing, learning new behaviors for the abdominal muscles, and maintaining relaxation during meals. […] Patients should start with small amounts of food and gradually increase the stomach’s ability to tolerate larger amounts of food and liquid. […] Patients should learn how to regulate the autonomic nervous system to allow for more relaxation and the management of trigger symptoms.

• #42 Rumination Disorder – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK576404/

  It is essential to take a proper clinical interview and correctly differentiate between vomiting and regurgitation. Rumination syndrome is severely underdiagnosed, which is most likely related to wrongly labeling regurgitation as vomiting. […] Prolonged intensive cognitive-behavioral therapy is often required, and patients need repetitive training to learn the diaphragmatic breathing pattern. Consistent patient education regarding the disease and behavioral modifications is essential for the improvement in patients’ symptoms. […] Once the diagnosis is made, clinical psychologists and behavioral therapists play a crucial role in treating these patients with intensive cognitive behavioral therapy, especially if they have underlying/associated psychiatric diseases.

• #43 Frontiers | Rumination Syndrome in Children and Adolescents: A Mini Review

  https://www.frontiersin.org/journals/pediatrics/articles/10.3389/fped.2021.709326/full

  While some patients may experience resolution of rumination following a basic introduction of competing responses such as diaphragmatic breathing, a significant proportion will continue to have ongoing symptoms or experience relapse. This is particularly true for those with co-morbid anxiety or depression and when experiencing stress. Most patients will be better served by an interdisciplinary team consisting of a medical provider, a mental health provider, and often a dietician, particularly in the setting of weight loss. Treatment begins with confirming the diagnosis, providing reassurance, and educating patients on the pathophysiology of rumination syndrome, including factors which may exacerbate symptoms. The role of the medical provider is to assess and treat co-morbid conditions (e.g., gastroesophageal reflux, constipation, nausea, abdominal pain) and/or biologic factors (e.g., inflammation, nerve sensitivity, motility issues) that may underlie or complicate rumination, and to consider medications to augment behavioral interventions for rumination. The role of the mental health provider is to assess and treat co-morbid psychological conditions that may serve a contributory role (e.g., anxiety, depression), improve autonomic balance and rest/digest functions via relaxation training, and engage the patient in habit reversal training focused on identification of effective competing responses and the optimal timing/triggers for their use.

• #44 Frontiers | Rumination Syndrome in Children and Adolescents: A Mini Review

  https://www.frontiersin.org/journals/pediatrics/articles/10.3389/fped.2021.709326/full

  While some patients may experience resolution of rumination following a basic introduction of competing responses such as diaphragmatic breathing, a significant proportion will continue to have ongoing symptoms or experience relapse. This is particularly true for those with co-morbid anxiety or depression and when experiencing stress. Most patients will be better served by an interdisciplinary team consisting of a medical provider, a mental health provider, and often a dietician, particularly in the setting of weight loss. Treatment begins with confirming the diagnosis, providing reassurance, and educating patients on the pathophysiology of rumination syndrome, including factors which may exacerbate symptoms. The role of the medical provider is to assess and treat co-morbid conditions (e.g., gastroesophageal reflux, constipation, nausea, abdominal pain) and/or biologic factors (e.g., inflammation, nerve sensitivity, motility issues) that may underlie or complicate rumination, and to consider medications to augment behavioral interventions for rumination. The role of the mental health provider is to assess and treat co-morbid psychological conditions that may serve a contributory role (e.g., anxiety, depression), improve autonomic balance and rest/digest functions via relaxation training, and engage the patient in habit reversal training focused on identification of effective competing responses and the optimal timing/triggers for their use.

• #45 Kevin William Grant—Registered Psychotherapist – Breaking Down Behavioral Interventions: Effective Strategies for Managing Rumination Syndrome

  https://www.kevinwgrant.com/blog/item/breaking-down-behavioral-interventions-effective-strategies-for-managing-rumination-syndrome

  Rumination Disorder, as outlined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR), is characterized by the repeated regurgitation of food after eating. […] Treatment often involves behavioral interventions to change the regurgitation habit and address contributing psychological issues (Chial et al., 2003). […] Given these challenges, increasing awareness and understanding of Rumination Disorder among healthcare professionals and the public is crucial. […] The treatment approaches often involve behavioral interventions, psychoeducation, and, in some cases, addressing any underlying psychological issues (Wagaman et al., 2016). […] A multidisciplinary treatment approach was initiated. This included: Behavioral Therapy: Focused on developing strategies to interrupt and prevent the regurgitation behavior, using techniques like diaphragmatic breathing and muscle relaxation.

• #46 Treatment Options For Rumination Disorder: Medications, Therapies, & More

  https://www.therecoveryvillage.com/mental-health/rumination-disorder/treatment/

  Rumination disorder can be treated through behavior modification, habit reversal training and diaphragmatic breathing exercises. […] Treatment for rumination disorder depends on accurate diagnosis and finding the underlying cause of the disorder. It also encompasses managing symptoms and reducing complications that may arise as a result of regurgitating food, rechewing it and swallowing it again. Rumination disorder treatment is primarily psychosocial or psychodynamic and consists of non-punishing behavioral strategies. […] According to the Nationwide Childrens Hospital, the goals for treating rumination disorder are: Education, Treating the trigger symptoms, Treating symptoms such as nausea or bloating, Undoing newly learned habits, Learning new behaviors for abdominal muscles, Retraining the stomach to hold food again, Teaching self-regulation, Identifying and addressing other problems like depression, anxiety and stress.

• #47 Rumination Syndrome | Safe Harbor Treatment Center

  https://safeharbortreatmentcenter.com/what-we-treat/co-occurring-disorders/rumination-syndrome/

  It is very important that patients and their families understand the diagnosis, so they do not worry that it is another condition or disease. Families who participate in treatment see the best results. […] Symptoms such as nausea or bloating that occur after eating should be treated to try to reduce the frequency of regurgitation. […] Treatment should include learning about how habits are formed, learning about what your abdominal muscles are doing, learning new behaviors for the abdominal muscles, and maintaining relaxation during meals. […] Patients should start with small amounts of food and gradually increase the stomach’s ability to tolerate larger amounts of food and liquid. […] Patients should learn how to regulate the autonomic nervous system to allow for more relaxation and the management of trigger symptoms.

• #48 Rumination Syndrome | Safe Harbor Treatment Center

  https://safeharbortreatmentcenter.com/what-we-treat/co-occurring-disorders/rumination-syndrome/

  Often times, patients will eat a meal while under the guidance of a behavioral psychologist in order to re-learn habits surrounding food. In addition to breathing techniques, this might also involve changes in posture while eating, removing distractions during meal times, reducing stress, and biofeedback (a technique used to learn to control some of your body’s functions). […] Breathing techniques are easy to learn and have proven to be very effective. For most people, the symptoms will vastly improve or disappear altogether. Early treatment is recommended in order to minimize the health risks and social effects that can occur from untreated rumination syndrome. […] To provide you with a straightforward list, the National Eating Disorder Association has compiled a list of important aspects of rumination syndrome treatment.

• #49 Rumination Syndrome – About Kids GI

  https://aboutkidsgi.org/upper-gi/rumination-syndrome/

  In general, early intervention with behavioral treatment is recommended in order to reduce adverse consequences related to school absenteeism, weight loss, extensive diagnostic testing, and hospitalization in this population. […] The outcome for children and adolescents with rumination syndrome who undergo behavioral treatment is very good. The vast majority will have significant improvement of their symptoms, and many report complete resolution of symptoms following treatment. […] Those with other medical or psychological conditions in addition to rumination syndrome may require additional therapeutic interventions.

• #50 Multidisciplinary Treatment Is Effective for Patients With Rumination Syndrome – Pediatrics Nationwide

  https://pediatricsnationwide.org/2023/03/27/multidisciplinary-treatment-for-rumination-syndrome-associates-with-high-rates-of-symptom-improvement/

  RS is a disorder that cannot be effectively treated by a GI doctor alone. It really requires a multidisciplinary team. Treatment of RS involves a GI doctor and a GI psychologist, and we oftentimes will involve one of our GI dieticians or more team members as well. I think [RS management] is a good example of how we can adapt, from a medical standpoint, to better serve the patient. It’s just a good example of the importance of multidisciplinary care.

• #51 Rumination Disorder: Bobbi’s Story | Children’s Mercy Kansas City

  https://www.childrensmercy.org/departments-and-clinics/gastroenterology/rumination-disorder-bobbis-story/

  Rumination disorder causes the backward flow of recently eaten food from the stomach to the mouth. The main treatment for rumination disorder is behavioral therapy. This may involve habit reversal strategies, relaxation, diaphragmatic breathing and biofeedback. Dr. Rosen recommended diaphragmatic breathing as a first-line treatment for Bobbi and taught her how to use it during her telehealth visit. […] The new Rumination Disorder Clinic is the only one in the region specializing in helping patients like Bobbi by offering a multidisciplinary approach to care, starting with a medical evaluation. Once any medical issues have been addressed, patients begin working on behavioral issues. […] When there is no medical cause for the problem, we focus on changing the habit or behavior. […] At her first visit, Dr. Schurman explained that at some point, Bobbis esophagus had learned to push food up in response to stress, and that she needed to retrain those muscles to push food down instead.

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