Rumination Syndrome Mayo Clinic Proceedings Allison Malcolm, M.B., B.S., Miriam B. Thumshirn, M.D., Michael Camilleri, M.D., Donald E. Williams, Ph.D.  Mayo Clinic Proceedings  Volume 72, Issue 7, Pages 646-652 (July 1997) DOI: 10.4065/72.7.646 Copyright © 1997 Mayo Foundation for Medical Education and Research Terms and Conditions

Fig. 1 Proposed pathophysiology of rumination. LES = lower esophageal sphincter. Mayo Clinic Proceedings 1997 72, 646-652DOI: (10.4065/72.7.646) Copyright © 1997 Mayo Foundation for Medical Education and Research Terms and Conditions

Fig. 2 Left, Twenty-four-hour pH study demonstrating acid in esophagus during meal, with no other episodes even when patient is supine, findings indicative of rumination. Note there is no associated pain. Right, Twenty-four-hour pH study demonstrating acid in esophagus predominantly when patient is supine, findings indicating gastroesophageal reflux. Note several episodes of pain are reported. Mayo Clinic Proceedings 1997 72, 646-652DOI: (10.4065/72.7.646) Copyright © 1997 Mayo Foundation for Medical Education and Research Terms and Conditions

Fig. 3 Gastrointestinal manometry and esophageal pH in patient with rumination. Note concurrence of regurgitation (arrows) with decreases in intraesophageal pH and “R” or simultaneous waves consistent with increased intra-abdominal pressure, desc. = descending. (From O'Brien and associates.14 By permission.) Mayo Clinic Proceedings 1997 72, 646-652DOI: (10.4065/72.7.646) Copyright © 1997 Mayo Foundation for Medical Education and Research Terms and Conditions

Fig. 4 Clinical approach to adult with suspected rumination. Postive (+) findings on history or gastrointestinal manometry signify features characteristic of rumination. Mayo Clinic Proceedings 1997 72, 646-652DOI: (10.4065/72.7.646) Copyright © 1997 Mayo Foundation for Medical Education and Research Terms and Conditions