Rumination syndrome is a functional gastrointestinal disorder characterized by effortless postprandial regurgitation and accompanied by gastric visceral hypersensitivity. Almost invariably, the onset of symptoms is preceded by a psychologically stressful situation, and anxiety is often an accompanying complaint. In this background of gastric visceral hypersensitivity, anxiety and psychological stress, we investigated the effectiveness of combining a tricyclic antidepressant (TCA) with diaphragmatic breathing/relaxation techniques for the treatment of rumination syndrome.
Materials and Methods
Patients who fulfilled the Rome IV criteria for rumination syndrome received hands-on instructions and/or coaching on diaphragmatic breathing techniques, were given relaxing auditory media, started on a TCA, and completed a follow-up symptoms questionnaire after undergoing a minimum of 3 months of this therapy.
A total of 44 patients, 35 women; mean age 40.4 (range 20-71) were identified. Mean time from onset of symptoms to diagnosis was 36.0 months (range 6-180). Weight loss ranged from 1.4 to 39.5 kg. Approximately 65.9% had a history of anxiety and/or depression, and a separate 65.9% reported the onset of symptoms were chronologically related to an inciting event and/or psychological stressor. After a mean follow-up period of 8.8 months, 90.9% of patients reported improvement in their symptoms, with a mean subjective improvement from baseline of 68.9%, and specifically, 45.5% of patients reported ≥80% improvement. Weight increased or stabilized in 80.6% of those initially reporting weight loss.
The combination of a TCA with diaphragmatic breathing/relaxation techniques is an effective treatment modality for the management of rumination syndrome as it addresses the underlying factors identified in this entity.
Key Indexing Terms
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to The American Journal of the Medical Sciences
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- The rumination syndrome: clinical features rather than manometric diagnosis.Gastroenterology. 1995; 108: 1024-1029
- The rumination syndrome in adults: a review of the pathophysiology, diagnosis and treatment.J Postgrad Med. 2007; 53: 203-206
- Managing a patient with rumination.Frontline Gastroenterol. 2013; 4: 232-236
- Epidemiology and health care seeking in the functional GI disorders: a population-based study.Am J Gastroenterol. 2002; 97: 2290-2299
- The epidemiology of functional gastrointestinal disorders in Mexico: a population-based study.Gastroenterol Res Pract. 2012; 2012606174
- Gastroduodenal disorders.Gastroenterology. 2016; 150: 1380-1392
- Diagnosis and treatment of rumination syndrome.Clin Gastroenterol Hepatol. 2018; 16: 1549-1555
- Gastric mechanosensory and lower esophageal sphincter function in rumination syndrome.Am J Physiol. 1998; 275: G314-G321
- Rumination variations: aetiology and classification of abnormal behavioural responses to digestive symptoms based on high-resolution manometry studies.Aliment Pharmacol Ther. 2013; 37: 263-274
- Novel association of rectal evacuation disorder and rumination syndrome: diagnosis, co-morbidities and treatment.United European Gastroenterol J. 2014; 2: 38-46
- The rumination syndrome: clinical and manometric profile, therapy, and long-term outcome.Dig Dis Sci. 1997; 42: 1866-1872
- Teaching diaphragmatic breathing for rumination syndrome.Am J Gastroenterol. 2006; 101: 2449-2452
- Treatment of functional GI disorders with psychotropic medicines: a review of evidence with a practical approach.Gastroenterol Hepatol (N Y). 2006; 2: 678-688
- Rumination syndrome: an update on diagnostic and treatment strategies.Pract Gastroenterol. 2016; 40: 68-73
- Review article: the pathophysiology, differential diagnosis and management of rumination syndrome.Aliment Pharmacol Ther. 2011; 33: 782-788
- Diaphragmatic breathing for rumination syndrome: efficacy and mechanisms of action.Neurogastroenterol Motil. 2016; 28: 384-391
- Cognitive-behavioral treatment of adult rumination behavior in the setting of disordered eating: a single case experimental design.Int J Eat Disord. 2016; 49: 967-972
- Behavioral assessment and treatment of postprandial regurgitation.J Clin Gastroenterol. 1987; 9: 679-684
- Behavioral intervention for the treatment of rumination.J Pediatr Gastroenterol Nutr. 1998; 27: 596-598
- Baclofen improves symptoms and reduces postprandial flow events in patients with rumination and supragastric belching.Clin Gastroenterol Hepatol. 2012; 10: 379-384
- A randomized double-blind, placebo-controlled, cross-over study using baclofen in the treatment of rumination syndrome.Am J Gastroenterol. 2018; 113: 97-104
- Clinical outcome of rumination syndrome in adults without psychiatric illness: a prospective study.J Gastroenterol Hepatol. 2007; 22: 1741-1747
- Effective treatment of rumination with Nissen fundoplication.J Gastrointest Surg. 2002; 6: 638-644
- Rumination syndrome in the setting of a Nissen fundoplication: its atypical clinical and diagnostic features.Pract Gastroenterol. 2019; 43: 40-44
- The rumination syndrome in adults. A characteristic manometric pattern.Ann Intern Med. 1986; 105: 513-518
- Objective manometric criteria for the rumination syndrome.Am J Gastroenterol. 2014; 109: 52-59
- Persistent postprandial regurgitation vs rumination in patients with refractory gastroesophageal reflux disease symptoms: identification of a distinct rumination pattern using ambulatory impedance-pH monitoring.Am J Gastroenterol. 2019; 114: 1248-1255
- Diagnosis and treatment of rumination syndrome: a critical review.Am J Gastroenterol. 2019; 114: 562-578
- Efficacy of antidepressants and psychological therapies in irritable bowel syndrome: systematic review and meta-analysis.Gut. 2009; 58: 367-378
- Tricyclic antidepressants for chronic vomiting in diabetic patients.Dig Dis Sci. 2007; 52: 418-424
- Effect of amitriptyline on symptoms, sleep, and visceral perception in patients with functional dyspepsia.Am J Gastroenterol. 1998; 93: 160-165
Published online: April 12, 2020
Accepted: April 1, 2020
Received: January 7, 2020
The authors have no conflicts of interest to disclose.
© 2020 Published by Elsevier Inc. on behalf of Southern Society for Clinical Investigation.