Rumination Syndrome

Important information:

Rumination syndrome is a disorder of gut-brain interaction (DGBI), sometimes called a functional GI disorder (FGID). It causes food and drinks to come back up into the throat or mouth soon after eating or drinking. This happens without force, unlike vomiting or gagging. Rumination usually occurs during or shortly after meals, snacks, and drinks and can happen multiple times a day.

When eating or drinking, food and liquids normally travel from the mouth down the esophagus (throat) into the stomach. In rumination syndrome, the stomach might feel uncomfortable after food or liquid enters. This discomfort causes the abdominal muscles to squeeze, placing pressure on the stomach. At the same time, the lower esophageal sphincter (a small trapdoor at the bottom of the esophagus) relaxes, allowing food or liquids to move easily back up the esophagus. If the abdominal muscles squeeze hard enough, the food or liquid will come all the way back into the mouth.

Rumination can start after an illness, a stressful life event, or due to other gastrointestinal (GI) symptoms like reflux. Sometimes, there is no clear cause. The condition occurs because of disrupted signals between the brain and stomach, creating a pattern of bringing food or liquids back up. Over time, this pattern becomes an automatic response to eating and drinking. It’s like the stomach learned to get rid of foods and liquids instead of keeping them down. This automatic response can be unlearned with the right treatment.

Patient instructions:

The best way to reduce rumination is with behavioral treatment. This often means working with a therapist or psychologist to retrain the body to keep foods and liquids down when eating or drinking. Managing other GI symptoms and family support are also important.

Practice diaphragmatic (belly) breathing daily.

• Lie down in a calm place and practice breathing deeply into your abdomen.

• Imagine your belly filling like a balloon as you breathe in.

• Slowly release the air and allow your belly to relax as you breathe out.

• Practice for a few minutes every day, such as before bed, to feel comfortable with this technique.

• Eat slowly and take smaller bites.

• Chew your food thoroughly before swallowing.

• Take smaller bites and pace yourself.

Re-swallow food or liquids. If food or liquid starts to come back up, calmly re-swallow it to keep it down.

Use diaphragmatic breathing during meals.

• Start belly breathing before eating and continue during and after meals.

• If you feel pressure, pain, or the urge to burp, begin belly breathing immediately to stop food or liquids from coming back up.

• Rumination will start to decrease when using diaphragmatic breathing regularly. This is because abdominal muscles cannot squeeze to bring food or liquids back up and expand to breathe at the same time.

Behavioral treatment with a therapist. Work with a psychologist or therapist to practice reswallowing and breathing skills to make these skills most successful. A therapist may also teach other strategies to reduce rumination. These might include recognizing triggers, practicing chewing techniques, adjusting eating habits, and learning skills to cope with possible worries or feelings about symptoms.

Manage other GI symptoms as recommended. If your care team has prescribed medicine or diet changes for symptoms like reflux or constipation, follow these instructions closely.

Parents and caregivers can help by:

• Staying calm if foods or liquids come back up.

• Limiting questions about symptoms to reduce focus on rumination.

• Reminding your child to take smaller bites, fully chew their food, and eat slowly.

• Encouraging daily practice of diaphragmatic breathing and other skills. For younger children, this may include using a reward chart to encourage them to practice.

Remember:

It takes time to retrain your body to keep foods and liquids down. Practicing these techniques consistently will help reduce rumination over time. Your care team, which may include medical providers, a psychologist, a dietitian, and a social worker, is here to support you every step of the way.

Reviewed February 2025 by Kari Baber PhD, Sarah Mayer-Brown PhD, Jennifer Webster DO