Rumination disorder is a rare and chronic condition that can be associated with a number of psychological conditions and is highly susceptible to damage to the esophagus. Characteristic of this disease is vomiting after eating very easily and regurgitation of regurgitated food unconsciously. Early treatment intervention is necessary to avoid inconvenience to life and limit the impact on health.
What is rumination disorder?
Rumination disorder is an eating disorder that has only been recognized in recent years. This syndrome is characterized by the reflux of undigested food from the stomach to the mouth (vomiting). Patients often chew the refluxed food and swallow it or spit it out.
In ruminant syndrome, food will come out very easily, not being secreted actively. People with this condition will usually eat one meal, then spit up the food within 30 minutes. May be accompanied by a sensation of belching and is usually not accompanied by nausea or vomiting.
Ruminant syndrome is common mainly in infants and young children but can occasionally occur in adults. For infants, this syndrome may resolve on its own after about 3-12 months. However, in children and adults, therapeutic intervention is required.
Manifestations of ruminant disorder
The frequency and severity of rumination syndrome will vary from person to person. Usually, however, a person will tend to regurgitate food within half an hour of eating. The vomited food has not been mixed with stomach acid and has no unpleasant taste. Therefore, it can be chewed and swallowed or spit out.
Other symptoms that may be present include:
- Vomiting is not forced, not preceded by douching
- gas before vomiting
- Discomfort in the abdomen, relieved after the food spilled out
- Chronic halitosis
- Losing weight, though not intended or not planned
- Chapped lips
In addition, rumination syndrome can also create anxiety and confusion. This often results from uncontrolled vomiting. Over time, the person may develop the following symptoms:
- Enamel wear or tooth decay
- Skip social gatherings or events
Causes of rumination disorder
Although there has been a lot of research, the exact cause of rumination disorder is still not clear. However, according to experts, it seems to be related to an increase in pressure inside the abdomen.
Ruminant syndrome is often confused with bulimia nervosa, gastroparesis, and gastroesophageal reflux disease. Some people have ruminant syndrome associated with rectal motility disorders. In which poor coordination of pelvic floor attacks leads to chronic constipation.
Rumination disorder has long been known to occur more commonly in infants and people with developmental disabilities. It is clear that this condition is not affected by age as it is likely to occur in both children, adolescents and adults.
Rumination syndrome can be a way to deal with emotional distress, which then has the potential to become a hard habit to break. It can occur in people with psychological disorders. Such as depression, anxiety disorders and other mental disorders.
Is rumination disorder dangerous?
As discussed, rumination disorder is characterized by regurgitation and rumination of food. This makes the patient feel uncomfortable when eating with other people. In addition, this disorder also makes patients afraid of eating, they often only tolerate very little food.
Most people with this disease face low weight conditions, malnutrition. Children with ruminant syndrome often have delayed growth in weight and height. In addition, patients may also experience tooth wear, bad breath, embarrassment, and a tendency to social isolation.
Diagnosis of rumination disorder
Diagnosing rumination syndrome can be a complex process. It is caused by other medical conditions that must be ruled out by a doctor. Expensive procedures or pending tests can also slow down the process.
Testing will be done to rule out gastrointestinal causes that may be causing the symptoms. Examples include gastroesophageal reflux disease (GERD) (stomach acid entering the esophagus), colic (a disorder of the esophagus’s motility) and gastroparesis (in which the stomach takes too long to to empty the container).
Tests performed may include:
- Esophageal endoscopy: This test allows your doctor to examine your esophagus, stomach, and duodenum to rule out any blockages. Your doctor may take a small tissue sample for further study.
- Stomach emptying: This procedure allows the doctor to know how long it takes for food to clear from the stomach. Alternatively, another form of this test can measure the time it takes for food to move through the small intestine and colon.
- Esophageal manometer: Help determine if the problem is related to the esophagus itself? If yes, in what part and to what extent? This test is commonly used to detect esophageal motility dysfunction.
After the gastroenterologist has ruled out the physical causes of the associated symptoms, the psychiatrist can diagnose rumination disorder. Diagnosis is made according to the criteria listed in the DSM-5:
- Food is regurgitated for at least 1 month, with or without chewing and swallowing.
- Vomiting is not related to any physical health condition.
- Vomiting or other symptoms not related to any other eating disorder. Includes bulimia nervosa, anorexia nervosa or bulimia.
- If vomiting occurs in conjunction with another mental health disorder such as an anxiety disorder or a neurodevelopmental disorder, the symptom must be severe enough to warrant a separate examination and diagnosis. .
How to treat rumination disorder
Treatment for rumination disorder can vary depending on the severity, age of the person, and the underlying mental health condition. Useful measures include:
1. Behavioral Therapy
The mainstay of treatment for rumination disorder is behavioral therapy to stop regurgitation early. The most commonly prescribed behavioral therapy for this syndrome is diaphragmatic breathing.
The diaphragm is a large dome-shaped muscle located at the base of the lungs. Diaphragm breathing can help you relax this muscle mass. Also use it correctly when breathing to increase strength.
Instructions for diaphragmatic breathing to help control regurgitation:
- Lie on your back on the bed, support your head and bend your knees. You can use a pillow under your knees to support your legs. You can also sit in a “meditation” position. Place one hand on your upper chest and the other just below your rib cage. This allows you to feel the movement of your diaphragm as you breathe.
- Inhale slowly through your nose so that your belly is facing out toward your hands. Keep the hand on your chest as still as possible. The hand on the stomach turns outward with each slow breath and moves inward as you exhale.
- Squeeze your abs so they drop inwards as you exhale with pursed lips. The hand on the upper chest should be kept as still as possible.
In addition, for people without developmental disabilities with ruminant syndrome, habit reversal behavioral therapy may be used. People learn to recognize when rumination occurs. At this time, the diaphragmatic breathing solution will be performed as instructed above.
Biofeedback is also part of behavioral therapy for rumination disorder. During biofeedback, images can help you or your child learn diaphragmatic breathing skills to combat regurgitation. Particularly for infants, treatment often focuses on working with parents or caregivers to change the child’s environment and behavior for the better.
2. Drug use
Rumination syndrome can trigger frequent regurgitation that damages the esophagus. In many cases, it also damages the lining of the esophagus and increases the risk of ulcers.
At this point, your doctor may prescribe some proton pump inhibitors to protect the lining of the esophagus until behavioral therapy reduces the frequency and severity of vomiting. .
The two most commonly prescribed medications include:
- Esomeprazole (Nexium)
- Omeprazole (Prilosec)
Additionally, some people with rumination syndrome may benefit from treatment with medications that help relax the stomach after eating. However, any medication should be taken as prescribed by a doctor. If there is an abnormality, please notify your doctor for timely correction.
3. Relaxation Techniques
In addition to using diaphragmatic breathing and taking certain medications when absolutely necessary, people with rumination disorder can benefit from relaxation techniques.
The two main solutions are yoga and hiking. They are very effective in reducing stress. Furthermore, it offers numerous benefits for both physical and mental health.
In addition, people with ruminant syndrome are advised to keep a diary or record how they feel each time they vomit. Take the initiative to talk to your doctor or seek counseling if you feel anxious or depressed.
Rumination syndrome usually does not affect a person’s daily routine. And in fact, many people with this syndrome can still live healthy lives. However, examination and treatment are essential to minimize the problems and avoid the problems that this disorder causes.