S1211 When Chew Is the Clue: Assessing Awareness of Rumination Syndrome Versus Bulimia Nervosa Among Providers in the GI Clinic: A Multicenter Prospective Study

Introduction: Rumination Syndrome, a functional gastroduodenal disorder characterized by effortless regurgitation of recently ingested food, is often misdiagnosed or conflated with eating disorders, particularly Bulimia Nervosa. Misclassification can lead to inappropriate referrals and delayed care. This study aimed to evaluate gastroenterology provider awareness and diagnostic differentiation between Rumination Syndrome and Bulimia Nervosa across multiple academic centers. Methods: A prospective survey-based study was conducted from January to October 2024 at 5 academic gastroenterology clinics. Gastroenterology attendings, fellows, nurse practitioners, and dietitians were anonymously surveyed using a 15-item questionnaire assessing knowledge of clinical features, diagnostic criteria, and management approaches for rumination syndrome versus bulimia nervosa. Clinical vignettes were included to assess diagnostic accuracy. Primary outcomes included correct identification of rumination syndrome and self-reported confidence in differentiating the 2 conditions. Results: A total of 212 providers participated (44% physicians, 32% trainees, 24% advanced practice providers). While 89% correctly identified diagnostic criteria for bulimia nervosa, only 46% accurately recognized key features of rumination syndrome. In clinical vignettes, 41% misdiagnosed rumination syndrome as an eating disorder. Only 27% reported confidence in managing rumination syndrome, compared to 68% for bulimia nervosa. Providers with prior exposure to functional GI training were significantly more likely to make accurate distinctions (P < 0.01). Conclusion: This multicenter prospective study reveals substantial gaps in gastroenterology provider awareness of rumination syndrome and its distinction from bulimia nervosa. Despite similar symptom presentations, the underlying pathophysiology and treatment approaches differ markedly, underscoring the need for targeted education. Improving diagnostic accuracy through focused training may reduce unnecessary psychiatric referrals, decrease healthcare utilization, and expedite appropriate behavioral interventions for functional GI disorders.