From the Guidelines
Rumination disorder management should prioritize a comprehensive approach combining behavioral techniques, dietary modifications, and supportive care, with a focus on diaphragmatic breathing and habit reversal therapy, as supported by the most recent evidence 1.
Key Components of Management
- Behavioral techniques: diaphragmatic breathing and habit reversal therapy to recognize and replace the urge to regurgitate with incompatible behaviors
- Dietary modifications: eating smaller, more frequent meals, thorough chewing, avoiding trigger foods, and remaining upright for 30-45 minutes after eating
- Supportive care: addressing underlying anxiety or stress contributing to the condition through psychotherapy, particularly cognitive-behavioral therapy
Diagnostic Considerations
- High-resolution manometry (HRM) with impedance after a test meal can be utilized to identify diagnostic features of rumination syndrome if the diagnosis is unclear 1
- Simultaneous impedance provides additional confirmatory and diagnostic information
Medication Management
- Proton pump inhibitors like omeprazole (20-40mg daily) or lansoprazole (15-30mg daily) may help manage associated acid reflux symptoms
- Baclofen (5-20mg three times daily) might reduce lower esophageal sphincter relaxation in some cases
Additional Therapies
- Biofeedback therapy using electromyography can help patients visualize and control abdominal muscle contractions
- Cognitive-behavioral therapy can address underlying anxiety or stress contributing to the condition The approach should be individualized, and the patient's response to different therapies should be closely monitored, as suggested by the British Society of Gastroenterology guidelines 1.
From the Research
Rumination Disorder Management
Rumination disorder is a condition where individuals repeatedly regurgitate and re-chew food, often accompanied by abdominal pain, nausea, and vomiting. Management of this condition involves a combination of behavioral interventions and cognitive-behavioral therapy (CBT).
- Cognitive-Behavioral Therapy (CBT): CBT has been shown to be effective in reducing symptoms of rumination disorder 2. A comprehensive CBT protocol, including awareness training, diaphragmatic breathing, and modularized interventions, can lead to significant reductions in regurgitations.
- Diaphragmatic Breathing: Diaphragmatic breathing is a technique that targets reflexive abdominal wall contraction in response to conditioned cues, such as food 2. This technique can be used in conjunction with CBT to enhance its effectiveness.
- Rumination-Focused Cognitive Behavioral Therapy (RF-CBT): RF-CBT is a specific type of CBT that targets rumination and has been shown to be effective in reducing depressive symptoms and preventing depression 3, 4.
- Web-Based Interventions: Web-based interventions, such as guided and unguided Rumination-Focused Cognitive Behavioral Therapy (i-RFCBT), have been shown to be feasible and effective in reducing symptoms of depression and anxiety 4.
Mechanisms Underlying Rumination
Rumination is a complex phenomenon that involves multiple mechanisms, including:
- Habit Development: Rumination can develop into a learned habit that involves the tendency to process negative information in an abstract way 5.
- Executive Control: Poor executive control can contribute to the development and maintenance of rumination 5.
- Negative Information-Processing Biases: Negative information-processing biases can also play a role in the development and maintenance of rumination 5.
Predicting Treatment Outcomes
Pretreatment levels of rumination can predict treatment outcomes in individuals with anxiety-related disorders 6. Higher levels of rumination have been associated with poorer treatment outcomes, highlighting the importance of addressing rumination in treatment.