Regurgitation happens when a mixture of gastric juices, and sometimes undigested food, rises back up the esophagus and into the mouth. Involuntary regurgitation is usually a symptom of acid reflux or GERD. Patients who regurgitate regularly but without any known cause may have a condition called rumination. Because rumination is confused with other gastrointestinal conditions such as acid reflux or GERD and the causes are not fully understood, some patients may not receive the proper treatment. Now, a new study by researchers at Massachusetts General Hospital (MGH) reports how to clearly distinguish rumination from other conditions, and how to treat it.

Their study, “Detection and characteristics of rumination syndrome in patients presenting for gastric symptom evaluation,” was published in the journal Neurogastroenterology & Motility.

“Rumination syndrome involves effortless, repeated regurgitation, and can overlap with other upper gastrointestinal disorders, including gastroparesis,” wrote the researchers. “To inform better diagnostic detection of rumination, we aimed to (1) identify frequency and characteristics of rumination in patients presenting for gastric symptom evaluation; and (2) assess demographic and clinical characteristics that could differentiate those with versus those without rumination.”

“This condition causes a lot of embarrassment and may stop people from eating with others,” explained Trisha Satya Pasricha, MD, co-lead author with Helen Burton Murray, PhD, both of MGH’s division of gastroenterology. “It is not well understood, and is often mistaken for other disorders.”

The researchers analyzed 242 patients who were referred to specialists for gastric symptom evaluation. “Thirty‐one of the 242 (12.8%) patients met criteria for rumination syndrome, of which 48% reported associated psychosocial impairment,” noted the researchers.

“There is little demographically that distinguishes these patients other than their tendency to regurgitate when eating,” explained Pasricha. “They are not more likely to have a history of an eating disorder or weight problems.”

The researchers found that screening for heartburn and regurgitation could help identify more patients with this condition.

The treatment for rumination is behavioral and involves the practice of diaphragmatic, or deep, breathing. Two pilot trials have shown that this significantly improves gastroesophageal reflux. Comprehensive cognitive behavioral therapy for rumination syndrome (CBT-RS) is also recommended.

The researchers’ findings will help patients get the proper treatment and can help those who have been misdiagnosed for more common gastrointestinal disorders.