RUMINATION SYNDROME: A NARRATIVE REVIEW OF AN UNDERRECOGNIZED FUNCTIONAL GASTROINTESTINAL DISORDER

Abstract

Background Rumination syndrome is an underrecognized disorder of gut–brain interaction characterized by recurrent, effortless postprandial regurgitation resulting from maladaptive behavioral and gastrointestinal motor mechanisms. Although growing evidence has improved understanding of its epidemiology, pathophysiology, diagnosis, and management, the available data remain fragmented, and comprehensive reviews integrating current knowledge are limited. Aim To provide a comprehensive narrative review of the current evidence on the clinical presentation, diagnosis, and management of rumination syndrome, with particular emphasis on recent advances and their implications for clinical practice. Materials and Methods Relevant literature was identified through structured searches of PubMed and Google Scholar. The primary search covered studies published between January 2016 and 1 July 2026, with earlier key or foundational publications additionally included when relevant. Sources addressing clinical presentation, diagnostic criteria or diagnostic methods, non-pharmacological treatment, or pharmacological treatment were considered. Eligible sources included randomized controlled trials, prospective or retrospective clinical studies, observational studies, systematic reviews, clinical guidelines, relevant experimental research, and clinical trial registrations. Following title and abstract screening and full-text evaluation, 44 sources were included in the final narrative review. Results Rumination syndrome is characterized by recurrent, effortless postprandial regurgitation, with clinical manifestations and disease severity differing according to age at symptom onset. Diagnosis is primarily based on clinical history and appropriate diagnostic criteria, including Rome IV in adults, Rome V in children and adolescents, and DSM-5. Postprandial high-resolution impedance manometry represents the reference standard for objective confirmation when required. Non-pharmacological interventions, particularly diaphragmatic breathing, together with biofeedback, behavioral therapy, patient education, and multidisciplinary management, represent the cornerstone of treatment. Pharmacological therapy has a limited adjunctive role. Baclofen currently has the strongest evidence among pharmacological agents, although the available evidence remains limited, while evidence supporting other medications is even less convincing. Conclusion Early recognition of the characteristic clinical presentation of rumination syndrome is essential for timely diagnosis and appropriate management. Diagnosis should be guided by age-appropriate criteria, with postprandial high-resolution impedance manometry providing objective confirmation when required. Behavioral interventions remain the mainstay of treatment, whereas pharmacological therapy has a limited adjunctive role. Earlier diagnosis and timely initiation of appropriate treatment may reduce unnecessary diagnostic investigations and improve clinical outcomes.