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Rumination.
Medical expert of the article
Last reviewed: 04.07.2025
Rumination (chewing gum) is a rare but very serious form of chronic regurgitation: it can cause a delay in growth and the rate of psychomotor and motor development of the child, especially in the second half of the first year of life.
There are no known cases in adults, as patients rarely report it. The pathophysiology of the disorder is not fully understood. There are no reports of reversal of peristalsis into rumination in humans. The disorder is probably an acquired, unfortunate habit and may be part of an eating disorder. The person acquires the ability to open the lower esophageal sphincter and move gastric contents into the esophagus and pharynx when gastric pressure increases through rhythmic contraction and relaxation of the diaphragm.
When chewing, regurgitation, chewing and re-swallowing of food occurs without nausea, but on the contrary, as a process that is definitely pleasant for the child, willingly repeated. Soon, chewing turns into a more or less fixed habitual neurosis. In order to regurgitate food, the child inserts a finger deep into the throat or sets the tongue in the form of a groove with the mouth wide open.
[ Causes of rumination
Rumination is believed to be a special type of repetitive self-stimulation and self-gratification, with the help of which the child compensates for the lack of appropriate external stimuli. In some cases, such children are deprived of calming tactile, visual or auditory sensations for a long time. In older children, the psychological factor plays an important role in maintaining rumination (as well as the habit of sucking a finger or tongue). In this case, the relationship between the mother (usually), father and child is disrupted, which is mainly due to the inability of adults to adequately perform their parental functions.
In some cases, regurgitation and rumination are caused by dysfunction of the esophagus, severe gastroesophageal reflux. It should be noted that primary disorders of the motor function of the esophagus, causing peristalsis disorders and dysphagia, are rare in children.
The lower esophageal sphincter prevents the reflux of gastric contents into the esophagus. If the function of this sphincter is impaired, the stomach contents move retrogradely, causing nutrient loss and, ultimately, malnutrition. However, in infants, there is no clear relationship between sphincter function and the severity of gastroesophageal reflux.
Long-term exposure of the lower esophageal mucosa to gastric juice may cause distal esophagitis (reflux esophagitis) or chronic blood loss. Esophageal dyskinesia, especially with dysfunction of the upper sphincter, may result in aspiration of gastric contents, which may cause prolonged, persistent cough, asthma attacks, and, in some cases, aspiration pneumonia.
Symptoms and diagnosis of rumination
Nausea, pain and dysphagia are not observed. At the moment of stress, the patient may not control the process of rumination. Observing this process for the first time, others may initiate the patient's visit to the doctor. Patients suffering from regurgitation rarely lose weight.
Rumination is usually diagnosed by observing the patient. A psychosocial history may help to identify an underlying cause, such as emotional stress. Upper gastrointestinal endoscopy is necessary to rule out conditions that could cause mechanical obstruction or Zenker's diverticulum. Esophageal manometry and esophageal, gastric, and duodenal transit studies may be used to detect motility disorders.
Treatment of rumination
Therapy is usually supportive. Medication is generally ineffective. Psychotherapy may be helpful in motivated patients (e.g., relaxation, biofeedback). Consultation with a psychiatrist may be helpful.