Materiały źródłowe

• #1 Rumination syndrome – UpToDate

  https://www.uptodate.com/contents/rumination-syndrome

  Rumination syndrome is a disorder of gut-brain interaction characterized by effortless regurgitation of ingested food into the mouth after most meals. The pathogenesis of rumination syndrome is unclear, but unperceived abdominal wall activation in the postprandial period appears to be a key pathogenetic feature. The exact trigger for this abdominal wall activation is not well established; however, as there is overlap between rumination syndrome and functional dyspepsia, it is possible that rumination events occur in response to post-prandial dyspeptic symptoms. […] The retrograde flow of ingested gastric content into the mouth in patients with rumination syndrome occurs due to a combination of raised intra-abdominal pressure coupled with negative intrathoracic pressure, resulting in a permissive esophagogastric gradient. On postprandial esophageal high resolution impedance manometry, rumination follows gastric pressurizations exceeding 30 mmHg, which is associated with lower and upper esophageal relaxation at the time of gastric pressurization. This indicates that raised intra-abdominal pressure alone cannot explain rumination and that upper and lower esophageal sphincter dysfunction also likely play a role.

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

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

  Rumination syndrome is a functional gastrointestinal disorder characterized by effortless postprandial regurgitation of ingested food into the mouth. An unperceived postprandial contraction of the abdominal wall could be a key mechanism. […] The pathophysiology of rumination syndrome is not yet completely understood, but unperceived activation of the abdominal wall in the postprandial period appears to be a cardinal pathogenic characteristic within the pathophysiologic process. Gastroduodenal manometry, and more recently the high-resolution esophageal impedance manometry technique, have shown that retrograde flow of the gastric content that reaches the buccal cavity in patients presenting with rumination is produced due to the simultaneous combination of elevated intra-abdominal pressure and negative intrathoracic pressure, resulting in an esophagogastric gradient in the direction of the oral cavity.

• #3 Rumination syndrome – UpToDate

  https://www.uptodate.com/contents/rumination-syndrome/print

  Rumination syndrome is a disorder of gut-brain interaction characterized by effortless regurgitation of ingested food into the mouth after most meals. The pathogenesis of rumination syndrome is unclear, but unperceived abdominal wall activation in the postprandial period appears to be a key pathogenetic feature. The retrograde flow of ingested gastric content into the mouth in patients with rumination syndrome occurs due to a combination of raised intra-abdominal pressure coupled with negative intrathoracic pressure, resulting in a permissive esophagogastric gradient. […] On postprandial esophageal high resolution impedance manometry, rumination follows gastric pressurizations exceeding 30 mmHg, which is associated with lower and upper esophageal relaxation at the time of gastric pressurization. This indicates that raised intra-abdominal pressure alone cannot explain rumination and that upper and lower esophageal sphincter dysfunction also likely play a role.

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

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

  Studies have shown that following the ingestion of food or fluids, patients with rumination syndrome frequently subconsciously and habitually contract their intercostal and anterior abdominal muscles. […] Contraction of the intercostal muscles results in costal expansion, while contraction of abdominal muscles including the rectus sheath and internal and external obliques increases intra-abdominal pressure. In conjunction with this, the lower oesophageal sphincter (LOS) relaxes. […] This is a reversal of the normal gastro-oesophageal pressure profile where at rest, intragastric pressure is normally low and LOS pressure is high. These resultant pressure changes result in gastric contents being propelled cranially into the oropharynx. […] Rumination syndrome is an acquired behavioural disorder and, in some cases, a detailed history can reveal a particular priming episode of psychological stress or gastrointestinal (GI) upset (eg, gastroenteritis) which occurred prior to rumination being noticed.

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

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

  Studies have shown that following the ingestion of food or fluids, patients with rumination syndrome frequently subconsciously and habitually contract their intercostal and anterior abdominal muscles.24 Contraction of the intercostal muscles results in costal expansion, while contraction of abdominal muscles including the rectus sheath and internal and external obliques increases intra-abdominal pressure. In conjunction with this, the lower oesophageal sphincter (LOS) relaxes.2527 This is a reversal of the normal gastro-oesophageal pressure profile where at rest, intragastric pressure is normally low and LOS pressure is high. These resultant pressure changes result in gastric contents being propelled cranially into the oropharynx (figures 1 and 2).28 […] Rumination syndrome is an acquired behavioural disorder and, in some cases, a detailed history can reveal a particular priming episode of psychological stress or gastrointestinal (GI) upset (eg, gastroenteritis) which occurred prior to rumination being noticed.29 30 This event may be relatively minor and swiftly forgotten but it is theorised it prompts patients to tense their abdominal walls in order to relieve discomfort.7 This initial priming episode, later maintained and reinforced, leads to patients habitually tensing their abdomen postprandially.24 While rumination is almost always a primary condition, it is recognised that rumination can occasionally be a secondary response to gastro-oesophageal reflux episodes (secondary rumination), where the rumination behaviour is thought to be a conditioned, maladaptive response to oesophageal discomfort caused by GORD.26 Similarly, patients with established rumination often report postprandial fullness or discomfort occurring before their episodes of regurgitation.7 Subsequent abdominal tensing and regurgitation may also be due to a subconscious, maladaptive method of discomfort reduction.

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

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

  Studies have shown that following the ingestion of food or fluids, patients with rumination syndrome frequently subconsciously and habitually contract their intercostal and anterior abdominal muscles.24 Contraction of the intercostal muscles results in costal expansion, while contraction of abdominal muscles including the rectus sheath and internal and external obliques increases intra-abdominal pressure. In conjunction with this, the lower oesophageal sphincter (LOS) relaxes.2527 This is a reversal of the normal gastro-oesophageal pressure profile where at rest, intragastric pressure is normally low and LOS pressure is high. These resultant pressure changes result in gastric contents being propelled cranially into the oropharynx (figures 1 and 2).28 […] Rumination syndrome is an acquired behavioural disorder and, in some cases, a detailed history can reveal a particular priming episode of psychological stress or gastrointestinal (GI) upset (eg, gastroenteritis) which occurred prior to rumination being noticed.29 30 This event may be relatively minor and swiftly forgotten but it is theorised it prompts patients to tense their abdominal walls in order to relieve discomfort.7 This initial priming episode, later maintained and reinforced, leads to patients habitually tensing their abdomen postprandially.24 While rumination is almost always a primary condition, it is recognised that rumination can occasionally be a secondary response to gastro-oesophageal reflux episodes (secondary rumination), where the rumination behaviour is thought to be a conditioned, maladaptive response to oesophageal discomfort caused by GORD.26 Similarly, patients with established rumination often report postprandial fullness or discomfort occurring before their episodes of regurgitation.7 Subsequent abdominal tensing and regurgitation may also be due to a subconscious, maladaptive method of discomfort reduction.

• #7 Rumination syndrome – UpToDate

  https://www.uptodate.com/contents/rumination-syndrome/print

  Rumination syndrome is a disorder of gut-brain interaction characterized by effortless regurgitation of ingested food into the mouth after most meals. The pathogenesis of rumination syndrome is unclear, but unperceived abdominal wall activation in the postprandial period appears to be a key pathogenetic feature. The retrograde flow of ingested gastric content into the mouth in patients with rumination syndrome occurs due to a combination of raised intra-abdominal pressure coupled with negative intrathoracic pressure, resulting in a permissive esophagogastric gradient. […] On postprandial esophageal high resolution impedance manometry, rumination follows gastric pressurizations exceeding 30 mmHg, which is associated with lower and upper esophageal relaxation at the time of gastric pressurization. This indicates that raised intra-abdominal pressure alone cannot explain rumination and that upper and lower esophageal sphincter dysfunction also likely play a role.

• #8 Rumination syndrome – UpToDate

  https://www.uptodate.com/contents/rumination-syndrome

  Rumination syndrome is a disorder of gut-brain interaction characterized by effortless regurgitation of ingested food into the mouth after most meals. The pathogenesis of rumination syndrome is unclear, but unperceived abdominal wall activation in the postprandial period appears to be a key pathogenetic feature. The exact trigger for this abdominal wall activation is not well established; however, as there is overlap between rumination syndrome and functional dyspepsia, it is possible that rumination events occur in response to post-prandial dyspeptic symptoms. […] The retrograde flow of ingested gastric content into the mouth in patients with rumination syndrome occurs due to a combination of raised intra-abdominal pressure coupled with negative intrathoracic pressure, resulting in a permissive esophagogastric gradient. On postprandial esophageal high resolution impedance manometry, rumination follows gastric pressurizations exceeding 30 mmHg, which is associated with lower and upper esophageal relaxation at the time of gastric pressurization. This indicates that raised intra-abdominal pressure alone cannot explain rumination and that upper and lower esophageal sphincter dysfunction also likely play a role.

• #9 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

  Rumination syndrome is a functional disorder characterized by the involuntary regurgitation of recently swallowed food from the stomach into the mouth, from where it can be re-chewed or expelled. […] The physical mechanism that generates regurgitation events is dependent on an involuntary process that alters abdominal and thoracic pressures accompanied by a permissive oesophageal-gastric junction. […] Regurgitation events in rumination syndrome occur when there is a gastro-oesophageal gradient that enables the stomach contents to flow towards the mouth. This gradient is produced when there is an increase in intra-abdominal pressure associated with negative intrathoracic pressure and a permissive gastro-oesophageal junction. […] A study conducted in patients with rumination syndrome using electromyography of the thoracoabdominal musculature found regurgitation events to be associated with contraction of the intercostal musculature (thoracic suction) accompanied by contraction of the anterior abdominal muscles (abdominal compression).

• #10 Rumination syndrome – UpToDate

  https://www.uptodate.com/contents/rumination-syndrome/print

  Rumination syndrome is a disorder of gut-brain interaction characterized by effortless regurgitation of ingested food into the mouth after most meals. The pathogenesis of rumination syndrome is unclear, but unperceived abdominal wall activation in the postprandial period appears to be a key pathogenetic feature. The retrograde flow of ingested gastric content into the mouth in patients with rumination syndrome occurs due to a combination of raised intra-abdominal pressure coupled with negative intrathoracic pressure, resulting in a permissive esophagogastric gradient. […] On postprandial esophageal high resolution impedance manometry, rumination follows gastric pressurizations exceeding 30 mmHg, which is associated with lower and upper esophageal relaxation at the time of gastric pressurization. This indicates that raised intra-abdominal pressure alone cannot explain rumination and that upper and lower esophageal sphincter dysfunction also likely play a role.

• #11 Rumination syndrome – UpToDate

  https://www.uptodate.com/contents/rumination-syndrome

  Rumination syndrome is a disorder of gut-brain interaction characterized by effortless regurgitation of ingested food into the mouth after most meals. The pathogenesis of rumination syndrome is unclear, but unperceived abdominal wall activation in the postprandial period appears to be a key pathogenetic feature. The exact trigger for this abdominal wall activation is not well established; however, as there is overlap between rumination syndrome and functional dyspepsia, it is possible that rumination events occur in response to post-prandial dyspeptic symptoms. […] The retrograde flow of ingested gastric content into the mouth in patients with rumination syndrome occurs due to a combination of raised intra-abdominal pressure coupled with negative intrathoracic pressure, resulting in a permissive esophagogastric gradient. On postprandial esophageal high resolution impedance manometry, rumination follows gastric pressurizations exceeding 30 mmHg, which is associated with lower and upper esophageal relaxation at the time of gastric pressurization. This indicates that raised intra-abdominal pressure alone cannot explain rumination and that upper and lower esophageal sphincter dysfunction also likely play a role.

• #12 Rumination syndrome and gastroparesis: Linked entities? | Revista de Gastroenterología de México

  https://www.revistagastroenterologiamexico.org/en-rumination-syndrome-gastroparesis-linked-entities-articulo-S2255534X2100027X

  Rumination syndrome (RS) is a functional gastrointestinal disorder characterized by effortless and repetitive regurgitation of ingested food from the stomach to the oral cavity, followed by either re-swallowing or spitting.1 It is produced by an increase in the intragastric pressure that is generated by a voluntary, unintentional contraction of the abdominal wall.1 RS appears to be underdiagnosed due to a lack of awareness among physicians, and it may be more common in females.2 […] The diagnosis of RS in adults is based on the ROME IV criteria. Although clinical suspicion is important, postprandial esophageal high-resolution impedance manometry (HRIM) supports the diagnosis. It shows gastric pressurizations exceeding 30mmHg that are associated with simultaneous upper and lower esophageal relaxation that is apparently closely related to the return of the ingested material into the esophagus and mouth, as well as to patient symptoms.1 Variants of rumination have been identified and can be differentiated by specific patterns.4 Increase in intragastric pressure followed by regurgitation is the most important characteristic distinguishing rumination from other disorders, such as gastroesophageal reflux. Treatment should be interdisciplinary and based on 3 points: an explanation of the condition and its underlying mechanism, diaphragmatic breathing, and visual feedback on the electromyogram (EMG) activity of the relevant muscles.

• #13 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

  Rumination syndrome is a functional disorder characterized by the involuntary regurgitation of recently swallowed food from the stomach into the mouth, from where it can be re-chewed or expelled. […] The physical mechanism that generates regurgitation events is dependent on an involuntary process that alters abdominal and thoracic pressures accompanied by a permissive oesophageal-gastric junction. […] Regurgitation events in rumination syndrome occur when there is a gastro-oesophageal gradient that enables the stomach contents to flow towards the mouth. This gradient is produced when there is an increase in intra-abdominal pressure associated with negative intrathoracic pressure and a permissive gastro-oesophageal junction. […] A study conducted in patients with rumination syndrome using electromyography of the thoracoabdominal musculature found regurgitation events to be associated with contraction of the intercostal musculature (thoracic suction) accompanied by contraction of the anterior abdominal muscles (abdominal compression).

• #14 Rumination Disorder | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/131534

  Rumination syndrome is believed to be an unintentionally acquired habit, possibly a learned adaptation of the belch reflex. The pathophysiology of rumination syndrome is not entirely understood and includes multiple overlapping mechanisms. […] The primary mechanism and key event include an often unperceived increase in the stimulation of all abdominothoracic muscles during eating, resulting in an increase in the intra-abdominal pressure. A concomitant expansion of the chest results in negative intrathoracic pressure. These changes and a proposed relaxation of the diaphragm, gastric fundus, and lower and upper esophageal sphincters, lead to increased intragastric pressure, facilitating the retrograde flow of food into the oral cavity. […] The simultaneous activation of all abdominothoracic muscles in patients with rumination syndrome can be appreciated as a characteristic „R” or retrograde wave on electromyography. Other contributory mechanisms include gastroesophageal reflux disease (GERD) and belching.

• #15

  https://europepmc.org/books/n/statpearls/article-131534/?extid=31536295&src=med

  Rumination syndrome is a functional gastrointestinal disorder defined as the effortless regurgitation of recently ingested food from the stomach back into the oral cavity in the absence of organic disease. […] The pathophysiology of rumination syndrome is not entirely understood and includes multiple overlapping mechanisms. […] The primary mechanism and key event include an often unperceived increase in the stimulation of all abdominothoracic muscles during eating, resulting in an increase in the intra-abdominal pressure. […] These changes and a proposed relaxation of the diaphragm, gastric fundus, and lower and upper esophageal sphincters, lead to increased intragastric pressure, facilitating the retrograde flow of food into the oral cavity. […] The simultaneous activation of all abdominothoracic muscles in patients with rumination syndrome can be appreciated as a characteristic „R” or retrograde wave on electromyography.

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

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

  Studies have shown that following the ingestion of food or fluids, patients with rumination syndrome frequently subconsciously and habitually contract their intercostal and anterior abdominal muscles. […] Contraction of the intercostal muscles results in costal expansion, while contraction of abdominal muscles including the rectus sheath and internal and external obliques increases intra-abdominal pressure. In conjunction with this, the lower oesophageal sphincter (LOS) relaxes. […] This is a reversal of the normal gastro-oesophageal pressure profile where at rest, intragastric pressure is normally low and LOS pressure is high. These resultant pressure changes result in gastric contents being propelled cranially into the oropharynx. […] Rumination syndrome is an acquired behavioural disorder and, in some cases, a detailed history can reveal a particular priming episode of psychological stress or gastrointestinal (GI) upset (eg, gastroenteritis) which occurred prior to rumination being noticed.

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

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

  Studies have shown that following the ingestion of food or fluids, patients with rumination syndrome frequently subconsciously and habitually contract their intercostal and anterior abdominal muscles.24 Contraction of the intercostal muscles results in costal expansion, while contraction of abdominal muscles including the rectus sheath and internal and external obliques increases intra-abdominal pressure. In conjunction with this, the lower oesophageal sphincter (LOS) relaxes.2527 This is a reversal of the normal gastro-oesophageal pressure profile where at rest, intragastric pressure is normally low and LOS pressure is high. These resultant pressure changes result in gastric contents being propelled cranially into the oropharynx (figures 1 and 2).28 […] Rumination syndrome is an acquired behavioural disorder and, in some cases, a detailed history can reveal a particular priming episode of psychological stress or gastrointestinal (GI) upset (eg, gastroenteritis) which occurred prior to rumination being noticed.29 30 This event may be relatively minor and swiftly forgotten but it is theorised it prompts patients to tense their abdominal walls in order to relieve discomfort.7 This initial priming episode, later maintained and reinforced, leads to patients habitually tensing their abdomen postprandially.24 While rumination is almost always a primary condition, it is recognised that rumination can occasionally be a secondary response to gastro-oesophageal reflux episodes (secondary rumination), where the rumination behaviour is thought to be a conditioned, maladaptive response to oesophageal discomfort caused by GORD.26 Similarly, patients with established rumination often report postprandial fullness or discomfort occurring before their episodes of regurgitation.7 Subsequent abdominal tensing and regurgitation may also be due to a subconscious, maladaptive method of discomfort reduction.

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

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

  Studies have shown that following the ingestion of food or fluids, patients with rumination syndrome frequently subconsciously and habitually contract their intercostal and anterior abdominal muscles.24 Contraction of the intercostal muscles results in costal expansion, while contraction of abdominal muscles including the rectus sheath and internal and external obliques increases intra-abdominal pressure. In conjunction with this, the lower oesophageal sphincter (LOS) relaxes.2527 This is a reversal of the normal gastro-oesophageal pressure profile where at rest, intragastric pressure is normally low and LOS pressure is high. These resultant pressure changes result in gastric contents being propelled cranially into the oropharynx (figures 1 and 2).28 […] Rumination syndrome is an acquired behavioural disorder and, in some cases, a detailed history can reveal a particular priming episode of psychological stress or gastrointestinal (GI) upset (eg, gastroenteritis) which occurred prior to rumination being noticed.29 30 This event may be relatively minor and swiftly forgotten but it is theorised it prompts patients to tense their abdominal walls in order to relieve discomfort.7 This initial priming episode, later maintained and reinforced, leads to patients habitually tensing their abdomen postprandially.24 While rumination is almost always a primary condition, it is recognised that rumination can occasionally be a secondary response to gastro-oesophageal reflux episodes (secondary rumination), where the rumination behaviour is thought to be a conditioned, maladaptive response to oesophageal discomfort caused by GORD.26 Similarly, patients with established rumination often report postprandial fullness or discomfort occurring before their episodes of regurgitation.7 Subsequent abdominal tensing and regurgitation may also be due to a subconscious, maladaptive method of discomfort reduction.

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

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

  This initial priming episode, later maintained and reinforced, leads to patients habitually tensing their abdomen postprandially. […] While rumination is almost always a primary condition, it is recognised that rumination can occasionally be a secondary response to gastro-oesophageal reflux episodes (secondary rumination), where the rumination behaviour is thought to be a conditioned, maladaptive response to oesophageal discomfort caused by GORD. […] Similarly, patients with established rumination often report postprandial fullness or discomfort occurring before their episodes of regurgitation. Subsequent abdominal tensing and regurgitation may also be due to a subconscious, maladaptive method of discomfort reduction.

• #20 Rumination Syndrome | Nationwide Children’s Hospital

  https://www.nationwidechildrens.org/conditions/rumination-syndrome

  Rumination syndrome falls into a category of GI conditions called functional gastrointestinal disorders (FGID). […] The problem results from dysregulation in the way the brain and the GI system communicate. Other factors such as nerve sensitivity in the GI tract or psychological stressors can make rumination symptoms worse. […] Medical histories of patients with rumination syndrome suggest that the symptoms often begin with some „triggering” event. This can be a viral infection, a GI disease, or even stress happening in the patients life. After this infection, event, or stress has gone away, the vomiting behavior remains in place, almost similar to a habit. As a consequence, when food or liquid enters the stomach, the body has learned a new behavior contraction of the abdominal muscles that results in pressure on the stomach and the food or fluid coming back up.

• #21 Rumination Syndrome – About Kids GI

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

  Rumination syndrome is characterized by the effortless regurgitation of recently ingested food into the mouth followed usually by expulsion, though in some people, or under certain circumstances, it is followed by re-chewing and re-swallowing. […] The cause of rumination is unknown. Because it is a functional GI disorder, rumination is not caused by an infection or by inflammation. […] In some children, rumination occurs at times of significant stress, as a manifestation of rejection, or in children who have previously suffered a more serious eating disorder such as bulimia nervosa. […] Medical histories of patients with rumination syndrome suggest that the symptoms often begin with some triggering event. This can be a viral infection, a GI disease, or even stress happening in the patients life. After this infection, event, or stress has gone away, the vomiting behavior remains in place, almost similar to a habit. As a consequence, when food or liquid enters the stomach, the body has learned a new behavior contraction of the abdominal muscles that results in pressure on the stomach and the food or fluid coming back up.

• #22 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

  From a psychopathological point of view, rumination in humans acts as a habit or reflex that develops as a result of a stimulus. […] The sensation of regurgitation is believed to temporarily resolve the premonitory urge, thus reinforcing the phenomenon of involuntary thoracoabdominal contractions. […] Kessing et al. studied patients diagnosed with rumination syndrome and GORD who reported very frequent episodes of regurgitation using high-resolution oesophageal manometry and 24-h ambulatory pH/impedance monitoring. In their study, they reported three mechanisms leading to episodes of rumination. The first mechanism or primary rumination is that which occurs spontaneously, with no identifiable triggering factor. […] The second mechanism or secondary rumination syndrome is that which occurs almost exclusively after an episode of gastro-oesophageal reflux. […] A third mechanism was recently reported in which episodes of rumination are preceded by supragastric belching.

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

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

  Studies have shown that following the ingestion of food or fluids, patients with rumination syndrome frequently subconsciously and habitually contract their intercostal and anterior abdominal muscles.24 Contraction of the intercostal muscles results in costal expansion, while contraction of abdominal muscles including the rectus sheath and internal and external obliques increases intra-abdominal pressure. In conjunction with this, the lower oesophageal sphincter (LOS) relaxes.2527 This is a reversal of the normal gastro-oesophageal pressure profile where at rest, intragastric pressure is normally low and LOS pressure is high. These resultant pressure changes result in gastric contents being propelled cranially into the oropharynx (figures 1 and 2).28 […] Rumination syndrome is an acquired behavioural disorder and, in some cases, a detailed history can reveal a particular priming episode of psychological stress or gastrointestinal (GI) upset (eg, gastroenteritis) which occurred prior to rumination being noticed.29 30 This event may be relatively minor and swiftly forgotten but it is theorised it prompts patients to tense their abdominal walls in order to relieve discomfort.7 This initial priming episode, later maintained and reinforced, leads to patients habitually tensing their abdomen postprandially.24 While rumination is almost always a primary condition, it is recognised that rumination can occasionally be a secondary response to gastro-oesophageal reflux episodes (secondary rumination), where the rumination behaviour is thought to be a conditioned, maladaptive response to oesophageal discomfort caused by GORD.26 Similarly, patients with established rumination often report postprandial fullness or discomfort occurring before their episodes of regurgitation.7 Subsequent abdominal tensing and regurgitation may also be due to a subconscious, maladaptive method of discomfort reduction.

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

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

  This initial priming episode, later maintained and reinforced, leads to patients habitually tensing their abdomen postprandially. […] While rumination is almost always a primary condition, it is recognised that rumination can occasionally be a secondary response to gastro-oesophageal reflux episodes (secondary rumination), where the rumination behaviour is thought to be a conditioned, maladaptive response to oesophageal discomfort caused by GORD. […] Similarly, patients with established rumination often report postprandial fullness or discomfort occurring before their episodes of regurgitation. Subsequent abdominal tensing and regurgitation may also be due to a subconscious, maladaptive method of discomfort reduction.

• #25 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

  From a psychopathological point of view, rumination in humans acts as a habit or reflex that develops as a result of a stimulus. […] The sensation of regurgitation is believed to temporarily resolve the premonitory urge, thus reinforcing the phenomenon of involuntary thoracoabdominal contractions. […] Kessing et al. studied patients diagnosed with rumination syndrome and GORD who reported very frequent episodes of regurgitation using high-resolution oesophageal manometry and 24-h ambulatory pH/impedance monitoring. In their study, they reported three mechanisms leading to episodes of rumination. The first mechanism or primary rumination is that which occurs spontaneously, with no identifiable triggering factor. […] The second mechanism or secondary rumination syndrome is that which occurs almost exclusively after an episode of gastro-oesophageal reflux. […] A third mechanism was recently reported in which episodes of rumination are preceded by supragastric belching.

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

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

  This initial priming episode, later maintained and reinforced, leads to patients habitually tensing their abdomen postprandially. […] While rumination is almost always a primary condition, it is recognised that rumination can occasionally be a secondary response to gastro-oesophageal reflux episodes (secondary rumination), where the rumination behaviour is thought to be a conditioned, maladaptive response to oesophageal discomfort caused by GORD. […] Similarly, patients with established rumination often report postprandial fullness or discomfort occurring before their episodes of regurgitation. Subsequent abdominal tensing and regurgitation may also be due to a subconscious, maladaptive method of discomfort reduction.

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

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

  Studies have shown that following the ingestion of food or fluids, patients with rumination syndrome frequently subconsciously and habitually contract their intercostal and anterior abdominal muscles.24 Contraction of the intercostal muscles results in costal expansion, while contraction of abdominal muscles including the rectus sheath and internal and external obliques increases intra-abdominal pressure. In conjunction with this, the lower oesophageal sphincter (LOS) relaxes.2527 This is a reversal of the normal gastro-oesophageal pressure profile where at rest, intragastric pressure is normally low and LOS pressure is high. These resultant pressure changes result in gastric contents being propelled cranially into the oropharynx (figures 1 and 2).28 […] Rumination syndrome is an acquired behavioural disorder and, in some cases, a detailed history can reveal a particular priming episode of psychological stress or gastrointestinal (GI) upset (eg, gastroenteritis) which occurred prior to rumination being noticed.29 30 This event may be relatively minor and swiftly forgotten but it is theorised it prompts patients to tense their abdominal walls in order to relieve discomfort.7 This initial priming episode, later maintained and reinforced, leads to patients habitually tensing their abdomen postprandially.24 While rumination is almost always a primary condition, it is recognised that rumination can occasionally be a secondary response to gastro-oesophageal reflux episodes (secondary rumination), where the rumination behaviour is thought to be a conditioned, maladaptive response to oesophageal discomfort caused by GORD.26 Similarly, patients with established rumination often report postprandial fullness or discomfort occurring before their episodes of regurgitation.7 Subsequent abdominal tensing and regurgitation may also be due to a subconscious, maladaptive method of discomfort reduction.

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

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

  Those observations reveal that the increase of intra-abdominal pressure, alone, cannot explain the rumination phenomenon, and that upper and lower esophageal sphincter relaxation most likely plays a central role in that process. […] In addition to the pathophysiologic mechanisms described, patients with rumination syndrome have been thought to present with a premonitory impulse, similar to that which occurs in patients with motor or vocal tics. It is an averse and disagreeable somatosensory experience the person has beforehand that is relieved after the rumination event, reinforcing the abdominal contraction. That recently described multiple mechanism model, or maintenance model, proposes that some patients could present with secondary psychologic and/or pathophysiologic mechanisms that contribute to the reinforcement process produced in response to the primary mechanism that maintains the usual contraction of the abdominal wall.

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

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

  Those observations reveal that the increase of intra-abdominal pressure, alone, cannot explain the rumination phenomenon, and that upper and lower esophageal sphincter relaxation most likely plays a central role in that process. […] In addition to the pathophysiologic mechanisms described, patients with rumination syndrome have been thought to present with a premonitory impulse, similar to that which occurs in patients with motor or vocal tics. It is an averse and disagreeable somatosensory experience the person has beforehand that is relieved after the rumination event, reinforcing the abdominal contraction. That recently described multiple mechanism model, or maintenance model, proposes that some patients could present with secondary psychologic and/or pathophysiologic mechanisms that contribute to the reinforcement process produced in response to the primary mechanism that maintains the usual contraction of the abdominal wall.

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

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

  Rumination syndrome involves recurrent regurgitation of food and is believed to be underdiagnosed with patients experiencing long delays in diagnosis. […] While physiologic changes that occur during a rumination episode are well-described, the underlying cause is less well-defined. In general, rumination appears to have similarities to other functional gastrointestinal disorders including dysmotility, possibly inflammation, and an interaction with psychologic function. […] It has been proposed that there may be three pathways to development of rumination: (1) a primary pathway involving premonitory urges (such as seen in tic disorders); (2) a pathway secondary to ongoing pathophysiology (such as gastroesophageal reflux); and, (3) a pathway secondary to psychosocial mechanisms stemming from a behavioral association which could begin in the presence of other FGIDs (e.g., to reduce pressure and pain in the stomach) and persist as a learned behavior in response to contextual clues (such as foods or changes in visceral sensation) after resolution of the other FGID.

• #31 Rumination Disorder | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/131534

  The maintenance of rumination is often associated with psychosocial diseases. Several smaller studies suggest that many patients with rumination syndrome have a higher burden of underlying somatic disorders, depression, or anxiety. […] A pathophysiologically distinct subtype of rumination syndrome is infantile rumination, which is related to emotional neglect.

• #32

  https://europepmc.org/books/n/statpearls/article-131534/?extid=31536295&src=med

  Other contributory mechanisms include gastroesophageal reflux disease (GERD) and belching. […] The maintenance of rumination is often associated with psychosocial diseases. […] A pathophysiologically distinct subtype of rumination syndrome is infantile rumination, which is related to emotional neglect.

• #33 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

  From a psychopathological point of view, rumination in humans acts as a habit or reflex that develops as a result of a stimulus. […] The sensation of regurgitation is believed to temporarily resolve the premonitory urge, thus reinforcing the phenomenon of involuntary thoracoabdominal contractions. […] Kessing et al. studied patients diagnosed with rumination syndrome and GORD who reported very frequent episodes of regurgitation using high-resolution oesophageal manometry and 24-h ambulatory pH/impedance monitoring. In their study, they reported three mechanisms leading to episodes of rumination. The first mechanism or primary rumination is that which occurs spontaneously, with no identifiable triggering factor. […] The second mechanism or secondary rumination syndrome is that which occurs almost exclusively after an episode of gastro-oesophageal reflux. […] A third mechanism was recently reported in which episodes of rumination are preceded by supragastric belching.

• #34 Rumination Syndrome – Guts UK

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

  Rumination syndrome is the chronic (long-term) repetitive, effortless regurgitation of recently swallowed food back into the mouth. The exact reason why some people can ruminate their food is not fully understood. Rumination occurs following an unintentional contraction of the abdominal muscles shortly after eating. This abruptly increases the pressure in the stomach to such an extent that it forces the valve in the lower oesophagus (gullet) to open allowing the food to travel back into the mouth. […] The cause is currently unknown. Some people report symptoms following an acute illness, surgeries, stress or a major life event. It is suggested that psychological symptoms may cause rumination syndrome, but also make it worse. However, it is noted that whilst 1 in 2 people have a mental health diagnosis, the other half do not.

• #35 Rumination Disorder | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/131534

  The maintenance of rumination is often associated with psychosocial diseases. Several smaller studies suggest that many patients with rumination syndrome have a higher burden of underlying somatic disorders, depression, or anxiety. […] A pathophysiologically distinct subtype of rumination syndrome is infantile rumination, which is related to emotional neglect.

• #36

  https://europepmc.org/books/n/statpearls/article-131534/?extid=31536295&src=med

  Other contributory mechanisms include gastroesophageal reflux disease (GERD) and belching. […] The maintenance of rumination is often associated with psychosocial diseases. […] A pathophysiologically distinct subtype of rumination syndrome is infantile rumination, which is related to emotional neglect.

• #37 Rumination syndrome and gastroparesis: Linked entities? | Revista de Gastroenterología de México

  https://www.revistagastroenterologiamexico.org/en-rumination-syndrome-gastroparesis-linked-entities-articulo-S2255534X2100027X

  Rumination syndrome (RS) is a functional gastrointestinal disorder characterized by effortless and repetitive regurgitation of ingested food from the stomach to the oral cavity, followed by either re-swallowing or spitting.1 It is produced by an increase in the intragastric pressure that is generated by a voluntary, unintentional contraction of the abdominal wall.1 RS appears to be underdiagnosed due to a lack of awareness among physicians, and it may be more common in females.2 […] The diagnosis of RS in adults is based on the ROME IV criteria. Although clinical suspicion is important, postprandial esophageal high-resolution impedance manometry (HRIM) supports the diagnosis. It shows gastric pressurizations exceeding 30mmHg that are associated with simultaneous upper and lower esophageal relaxation that is apparently closely related to the return of the ingested material into the esophagus and mouth, as well as to patient symptoms.1 Variants of rumination have been identified and can be differentiated by specific patterns.4 Increase in intragastric pressure followed by regurgitation is the most important characteristic distinguishing rumination from other disorders, such as gastroesophageal reflux. Treatment should be interdisciplinary and based on 3 points: an explanation of the condition and its underlying mechanism, diaphragmatic breathing, and visual feedback on the electromyogram (EMG) activity of the relevant muscles.

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

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

  Studies have shown that following the ingestion of food or fluids, patients with rumination syndrome frequently subconsciously and habitually contract their intercostal and anterior abdominal muscles.24 Contraction of the intercostal muscles results in costal expansion, while contraction of abdominal muscles including the rectus sheath and internal and external obliques increases intra-abdominal pressure. In conjunction with this, the lower oesophageal sphincter (LOS) relaxes.2527 This is a reversal of the normal gastro-oesophageal pressure profile where at rest, intragastric pressure is normally low and LOS pressure is high. These resultant pressure changes result in gastric contents being propelled cranially into the oropharynx (figures 1 and 2).28 […] Rumination syndrome is an acquired behavioural disorder and, in some cases, a detailed history can reveal a particular priming episode of psychological stress or gastrointestinal (GI) upset (eg, gastroenteritis) which occurred prior to rumination being noticed.29 30 This event may be relatively minor and swiftly forgotten but it is theorised it prompts patients to tense their abdominal walls in order to relieve discomfort.7 This initial priming episode, later maintained and reinforced, leads to patients habitually tensing their abdomen postprandially.24 While rumination is almost always a primary condition, it is recognised that rumination can occasionally be a secondary response to gastro-oesophageal reflux episodes (secondary rumination), where the rumination behaviour is thought to be a conditioned, maladaptive response to oesophageal discomfort caused by GORD.26 Similarly, patients with established rumination often report postprandial fullness or discomfort occurring before their episodes of regurgitation.7 Subsequent abdominal tensing and regurgitation may also be due to a subconscious, maladaptive method of discomfort reduction.

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

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

  This initial priming episode, later maintained and reinforced, leads to patients habitually tensing their abdomen postprandially. […] While rumination is almost always a primary condition, it is recognised that rumination can occasionally be a secondary response to gastro-oesophageal reflux episodes (secondary rumination), where the rumination behaviour is thought to be a conditioned, maladaptive response to oesophageal discomfort caused by GORD. […] Similarly, patients with established rumination often report postprandial fullness or discomfort occurring before their episodes of regurgitation. Subsequent abdominal tensing and regurgitation may also be due to a subconscious, maladaptive method of discomfort reduction.

• #40 Rumination Syndrome Symptoms and Causes – Apollo Hospitals Blog

  https://www.apollohospitals.com/diseases-and-conditions/rumination-syndrome

  The exact etiology of rumination syndrome is unknown. However, it appears to be due to an increase in abdominal pressure. […] Rumination syndrome is often confused with bulimia nervosa, gastroparesis and gastroesophageal reflux disease (GERD). […] Some individuals have rumination syndrome, which links to a rectal clearance disorder in which the pelvic floor muscles are out of sync, resulting in chronic constipation. […] The disease occurs in newborns and adults with developmental impairments. It is now evident that it is not age-related because it can affect children, teenagers, and adults. Rumination syndrome is more prone to occur in those suffering from depression, anxiety or other psychiatric disorders. […] The precise causes of the rumination problem are unknown. Some people experience this if they are have emotional difficulties or if they are going through a difficult time. Children and adults who experience a lot of stress may be more prone to rumination syndrome.

• #41 Rumination Syndrome Symptoms and Causes – Apollo Hospitals Blog

  https://www.apollohospitals.com/diseases-and-conditions/rumination-syndrome

  The exact etiology of rumination syndrome is unknown. However, it appears to be due to an increase in abdominal pressure. […] Rumination syndrome is often confused with bulimia nervosa, gastroparesis and gastroesophageal reflux disease (GERD). […] Some individuals have rumination syndrome, which links to a rectal clearance disorder in which the pelvic floor muscles are out of sync, resulting in chronic constipation. […] The disease occurs in newborns and adults with developmental impairments. It is now evident that it is not age-related because it can affect children, teenagers, and adults. Rumination syndrome is more prone to occur in those suffering from depression, anxiety or other psychiatric disorders. […] The precise causes of the rumination problem are unknown. Some people experience this if they are have emotional difficulties or if they are going through a difficult time. Children and adults who experience a lot of stress may be more prone to rumination syndrome.

• #42 Rumination Disorder | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/131534

  Rumination syndrome is believed to be an unintentionally acquired habit, possibly a learned adaptation of the belch reflex. The pathophysiology of rumination syndrome is not entirely understood and includes multiple overlapping mechanisms. […] The primary mechanism and key event include an often unperceived increase in the stimulation of all abdominothoracic muscles during eating, resulting in an increase in the intra-abdominal pressure. A concomitant expansion of the chest results in negative intrathoracic pressure. These changes and a proposed relaxation of the diaphragm, gastric fundus, and lower and upper esophageal sphincters, lead to increased intragastric pressure, facilitating the retrograde flow of food into the oral cavity. […] The simultaneous activation of all abdominothoracic muscles in patients with rumination syndrome can be appreciated as a characteristic „R” or retrograde wave on electromyography. Other contributory mechanisms include gastroesophageal reflux disease (GERD) and belching.

• #43

  https://europepmc.org/books/n/statpearls/article-131534/?extid=31536295&src=med

  Other contributory mechanisms include gastroesophageal reflux disease (GERD) and belching. […] The maintenance of rumination is often associated with psychosocial diseases. […] A pathophysiologically distinct subtype of rumination syndrome is infantile rumination, which is related to emotional neglect.

• #44 Rumination Syndrome Symptoms and Causes – Apollo Hospitals Blog

  https://www.apollohospitals.com/diseases-and-conditions/rumination-syndrome

  The exact etiology of rumination syndrome is unknown. However, it appears to be due to an increase in abdominal pressure. […] Rumination syndrome is often confused with bulimia nervosa, gastroparesis and gastroesophageal reflux disease (GERD). […] Some individuals have rumination syndrome, which links to a rectal clearance disorder in which the pelvic floor muscles are out of sync, resulting in chronic constipation. […] The disease occurs in newborns and adults with developmental impairments. It is now evident that it is not age-related because it can affect children, teenagers, and adults. Rumination syndrome is more prone to occur in those suffering from depression, anxiety or other psychiatric disorders. […] The precise causes of the rumination problem are unknown. Some people experience this if they are have emotional difficulties or if they are going through a difficult time. Children and adults who experience a lot of stress may be more prone to rumination syndrome.

• #45 Rumination syndrome – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/rumination-syndrome/symptoms-causes/syc-20377330

  Rumination syndrome is a condition in which someone repeatedly regurgitates undigested or partially digested food from the stomach. […] The exact cause of rumination syndrome isn’t clear. But it appears to be caused by an increase in abdominal pressure. […] Rumination syndrome is more likely to happen in people with anxiety, depression or other psychiatric disorders.

• #46 Rumination syndrome and gastroparesis: Linked entities? | Revista de Gastroenterología de México

  https://www.revistagastroenterologiamexico.org/en-rumination-syndrome-gastroparesis-linked-entities-articulo-S2255534X2100027X

  Rumination syndrome (RS) is a functional gastrointestinal disorder characterized by effortless and repetitive regurgitation of ingested food from the stomach to the oral cavity, followed by either re-swallowing or spitting.1 It is produced by an increase in the intragastric pressure that is generated by a voluntary, unintentional contraction of the abdominal wall.1 RS appears to be underdiagnosed due to a lack of awareness among physicians, and it may be more common in females.2 […] The diagnosis of RS in adults is based on the ROME IV criteria. Although clinical suspicion is important, postprandial esophageal high-resolution impedance manometry (HRIM) supports the diagnosis. It shows gastric pressurizations exceeding 30mmHg that are associated with simultaneous upper and lower esophageal relaxation that is apparently closely related to the return of the ingested material into the esophagus and mouth, as well as to patient symptoms.1 Variants of rumination have been identified and can be differentiated by specific patterns.4 Increase in intragastric pressure followed by regurgitation is the most important characteristic distinguishing rumination from other disorders, such as gastroesophageal reflux. Treatment should be interdisciplinary and based on 3 points: an explanation of the condition and its underlying mechanism, diaphragmatic breathing, and visual feedback on the electromyogram (EMG) activity of the relevant muscles.

• #47 Rumination syndrome and gastroparesis: Linked entities? | Revista de Gastroenterología de México

  https://www.revistagastroenterologiamexico.org/en-rumination-syndrome-gastroparesis-linked-entities-articulo-S2255534X2100027X

  Rumination syndrome (RS) is a functional gastrointestinal disorder characterized by effortless and repetitive regurgitation of ingested food from the stomach to the oral cavity, followed by either re-swallowing or spitting.1 It is produced by an increase in the intragastric pressure that is generated by a voluntary, unintentional contraction of the abdominal wall.1 RS appears to be underdiagnosed due to a lack of awareness among physicians, and it may be more common in females.2 […] The diagnosis of RS in adults is based on the ROME IV criteria. Although clinical suspicion is important, postprandial esophageal high-resolution impedance manometry (HRIM) supports the diagnosis. It shows gastric pressurizations exceeding 30mmHg that are associated with simultaneous upper and lower esophageal relaxation that is apparently closely related to the return of the ingested material into the esophagus and mouth, as well as to patient symptoms.1 Variants of rumination have been identified and can be differentiated by specific patterns.4 Increase in intragastric pressure followed by regurgitation is the most important characteristic distinguishing rumination from other disorders, such as gastroesophageal reflux. Treatment should be interdisciplinary and based on 3 points: an explanation of the condition and its underlying mechanism, diaphragmatic breathing, and visual feedback on the electromyogram (EMG) activity of the relevant muscles.

• #48 Rumination syndrome – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/rumination-syndrome/diagnosis-treatment/drc-20377333

  To diagnose rumination syndrome, a healthcare professional asks about current symptoms and takes a medical history. This first examination, combined with observing behavior, is often enough to diagnose rumination syndrome. […] Sometimes, tests such as high-resolution esophageal manometry and impedance measurement are used to confirm the diagnosis. This testing shows whether there is increased pressure in the abdomen. It also can provide an image of the irregular function for use in behavioral therapy. […] Treatment for rumination syndrome takes place after ruling out other disorders and depends on age and cognitive ability. […] Habit-reversal behavior therapy is used to treat people without developmental disabilities who have rumination syndrome. First, you learn to recognize when rumination happens. When rumination starts, you use the abdominal muscles to breathe in and out. This technique is called diaphragmatic breathing. Diaphragmatic breathing prevents abdominal contractions and regurgitation.

• #49 Rumination Syndrome | 5-Minute Clinical Consult

  https://www.unboundmedicine.com/5minute/view/5-Minute-Clinical-Consult/1688626/all/Rumination_Syndrome?q=Dysphagia

  Pathogenesis of rumination syndrome is unclear. Postprandial regurgitation is thought to occur secondary to coordinated increased intragastric pressures, lower esophageal sphincter (LES) relaxation, and decreased intrathoracic pressures resulting in a pressure gradient between the esophagus and stomach that exceeds the barrier pressure of the LES. Additionally, there may be an additional central reflex mechanism associated with episodes of rumination (1,2)[C]. […] Gastroduodenal manometry has shown R (rumination) waves, likely due to an abrupt increase in intra-abdominal pressure associated with rumination episodes; high-resolution esophageal manometry with impedance has shown gastric pressures 30 mm Hg associated with rumination events; abdominal wall electromyography (EMG) shows activation of abdominal wall musculature associated with rumination events.

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

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

  The significance of a low LES pressure has also been highlighted in some of the studies. […] Reasons for this low LES pressure can be a learned prolonged postprandial voluntary relaxation of the diaphragmatic crura or increased TLESRs. […] Other suggested possibilities include increased abdominal pressure displacing the EGJ proximally away from the crura thus losing the crural contribution to the EGJ. […] An unrecognized central mechanism may also be involved since healthy adults are not able to induce rumination. […] 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. […] DB can directly augment the tone of the LES by voluntary contraction of the crural diaphragm.

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

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

  The significance of a low LES pressure has also been highlighted in some of the studies. […] Reasons for this low LES pressure can be a learned prolonged postprandial voluntary relaxation of the diaphragmatic crura or increased TLESRs. […] Other suggested possibilities include increased abdominal pressure displacing the EGJ proximally away from the crura thus losing the crural contribution to the EGJ. […] An unrecognized central mechanism may also be involved since healthy adults are not able to induce rumination. […] 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. […] DB can directly augment the tone of the LES by voluntary contraction of the crural diaphragm.

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

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

  The significance of a low LES pressure has also been highlighted in some of the studies. […] Reasons for this low LES pressure can be a learned prolonged postprandial voluntary relaxation of the diaphragmatic crura or increased TLESRs. […] Other suggested possibilities include increased abdominal pressure displacing the EGJ proximally away from the crura thus losing the crural contribution to the EGJ. […] An unrecognized central mechanism may also be involved since healthy adults are not able to induce rumination. […] 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. […] DB can directly augment the tone of the LES by voluntary contraction of the crural diaphragm.

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

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

  DB can also prevent the increased intra-gastric pressure from displacing the EGJ proximally, thus not allowing a permissive EGJ during such episodes. […] DB may also alter vagal activity and prevent TLESRs from happening and thus maintain a more prolonged high pressure LES tone. […] Baclofen reduced the number of rumination episodes possibly by reduction in TLESRs and increasing postprandial LES pressure which were both significantly different in the intervention group compared to placebo. […] These mechanisms are similar in those postulated to take place post-DB.

• #54 Rumination Syndrome – Guts UK

  https://gutscharity.org.uk/advice-and-information/conditions/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. […] Baclofen has been shown to reduce the relaxations of the lower gullet which occur during regurgitation. It reduces reflux events and has been used to treat GERD. It has been shown in a clinical study to reduce the flow/ regurgitation events in people with Rumination. […] 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.

• #55 Rumination syndrome – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/rumination-syndrome/diagnosis-treatment/drc-20377333

  Biofeedback is part of behavior therapy for rumination syndrome. During biofeedback, imaging can help you or your child learn diaphragmatic breathing skills to counteract regurgitation. […] 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.

• #56 Rumination Syndrome – Guts UK

  https://gutscharity.org.uk/advice-and-information/conditions/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. […] Baclofen has been shown to reduce the relaxations of the lower gullet which occur during regurgitation. It reduces reflux events and has been used to treat GERD. It has been shown in a clinical study to reduce the flow/ regurgitation events in people with Rumination. […] 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.

• #57 Rumination syndrome: Diagnostic and therapeutic difficulties of a not so uncommon disorder | Anales de Pediatría

  https://www.analesdepediatria.org/en-rumination-syndrome-diagnostic-therapeutic-difficulties-articulo-S234128791730220X

  The treatment of rumination syndrome aims to modify the underlying mechanism that causes it, that is, the voluntary contraction of the abdominal wall, by abdominal retraining techniques. Biofeedback is a widely used method in medicine. A feedback system provides the patient with information on a physiological activity that the patient is performing incorrectly unconsciously but voluntarily, so that the patient can correct it consciously and voluntarily. The use of biofeedback for treatment of rumination consists in monitoring abdominothoracic muscular activity by means of electromyography and training the patient to relax abdominal and intercostal muscles to prevent further episodes in the course of 3 sessions.

• #58 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/

  Rumination syndrome (RS) is a unique, functional gastroenterological disorder characterized by effortless post-prandial regurgitation. […] Although the exact pathophysiology of RS in humans is not completely understood, it is currently believed to be an unconscious, learned disorder. The rumination episodes involve relaxation of the diaphragm combined with contraction of the abdominal muscles. The lower esophageal sphincter (LES) pressure is overcome by the increase in intraabdominal and intragastric pressure. […] Essentially, the patient is trapped in this post-prandial reflex and their stomach has been programmed to respond to oral intake in this manner at every meal, every day.

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