Regurgitation is the spitting up of food from the esophagus or stomach without nausea or forceful contractions of the abdominal muscles. Rumination is regurgitation with no apparent physical cause.
Regurgitation and rumination do not cause nausea, pain, or difficulty swallowing.
Regurgitation
A ring-shaped muscle (sphincter) between the stomach and esophagus normally helps prevent regurgitation.
Regurgitation of sour-tasting or bitter-tasting material can result from acid coming up from the stomach.
Regurgitation of tasteless fluid containing mucus or undigested food can result from a narrowing (stricture) or a blockage of the esophagus or from an abnormal pouch in the esophagus called a Zenker diverticulum. The blockage may result from acid damage to the esophagus, ingestion of caustic substances, cancer of the esophagus, or abnormal nerve control that interferes with coordination between the esophagus and its sphincter at the opening to the stomach (achalasia).
Rumination
Regurgitation sometimes occurs with no apparent physical cause. Such regurgitation is called rumination.
In rumination, small amounts of food are regurgitated from the stomach, usually 15 to 30 minutes after eating. The material often passes all the way to the mouth where a person may chew it again and reswallow it.
Rumination is usually involuntary. However, for some people, the disorder is probably a learned habit and may be part of an eating disorder. Some people are able to voluntarily open their lower esophageal sphincter and propel stomach contents into the esophagus and throat by increasing pressure in the stomach via rhythmic contraction and relaxation of the diaphragm (the muscle that separates the chest from the abdomen and that is responsible for each breath).
Rumination is common among infants. In adults, rumination most often occurs among people who have emotional disorders, especially during periods of stress.
Diagnosis of Regurgitation and Rumination
A doctor's examination
Sometimes endoscopy, esophageal motility tests, or both
Rumination is usually diagnosed through observation.
Doctors sometimes look in the esophagus and stomach with a flexible tube (endoscopy) to rule out a blockage of the esophagus or a Zenker diverticulum.
Sometimes doctors may do esophageal motility tests called esophageal manometry. In motility tests, people swallow a thin tube containing multiple pressure sensors. As people swallow, the pressure sensors show whether the esophagus is contracting normally and whether the lower part of the esophagus is relaxing normally.
They may do other tests to determine whether the stomach is emptying too slowly.
Treatment of Regurgitation and Rumination
Behavioral techniques
Rumination may be helped by doing behavioral techniques such as relaxation, biofeedback, or training in how to use the diaphragm instead of chest muscles to breathe.
For some people, an evaluation by a psychiatrist may be helpful.
