S4491 Behind the Regurgitation: Diagnosing Rumination

Introduction: Rumination syndrome is a disorder of gut-brain interaction characterized by effortless regurgitation of recently ingested, undigested food. Its pathophysiology remains incompletely understood but is often associated with psychiatric conditions, including eating disorders. Differentiating rumination syndrome from vomiting-related conditions and eating disorders can be challenging due to overlapping symptoms. We report a case of rumination syndrome in a young woman with a history of binge eating/purging, highlighting diagnostic and management considerations. Case Description: A 21-year-old woman presented to our outpatient clinic with unintentional weight loss, chronic abdominal pain, and persistent vomiting. She had been under psychiatric care and had previously been labeled with an eating disorder. On detailed history, she reported involuntary regurgitation of undigested food shortly after meals, accompanied by abdominal pain and weight loss. Esophagogastroduodenoscopy with biopsies was unremarkable, and a barium esophagram revealed only mild reflux. A gastric emptying study and high-resolution resolution esophageal manometry/impedance were attempted but were incomplete/not tolerated. A computed tomography angiography (CTA) excluded mesenteric ischemia. Based on clinical criteria, she was diagnosed with rumination syndrome. Treatment comprised of patient education, diaphragmatic breathing techniques and given pain was a predominant symptom, a neuromodulator was initiated, resulting in a diminution in symptoms and modest weight gain. Discussion: Rumination syndrome is diagnosed according to the Rome IV criteria; the central diagnostic features being effortless regurgitation of undigested food. However, coexisting symptoms, such as weight loss and abdominal pain, necessitate a thorough evaluation to exclude organic causes. The cornerstone of management of rumination is patient education and diaphragmatic breathing. Future research should explore the interplay between rumination syndrome and eating disorders to optimize diagnostic algorithms and therapeutic strategies.