Inpatient Treatment of Rumination Syndrome: Outcomes and Lessons Learned

Abstract

This retrospective analysis describes adolescent patients seeking treatment for rumination syndrome (RS) in an inpatient medical setting. It is the first study to examine clinical outcomes of patients involved in such an intensive multidisciplinary program. The analysis also explores factors that may be related to patients’ progress in the program. A chart review was conducted of 55 adolescents admitted to our program with RS over the course of 5 years. At admission, none of the patients was able to keep down enough caloric content by mouth to maintain weight. Variables examined included demographics, aspects of their illness (e.g., somatic symptoms, duration of illness), and progress with regard to rumination and ability to retain oral intake. By the end of treatment (Mdnlength of stay = 9.0 days), 87% of patients were able to successfully retain at least 80% of their daily caloric requirement by mouth. Patients who were not able to achieve this goal were more likely to have a comorbid mental health disorder. Anxiety disorder and depression were the 2 most common diagnoses. This analysis demonstrates the effectiveness of an multidisciplinary inpatient approach in the treatment of RS in what is likely a group of patients with challenging clinical presentations. It also highlights the importance of evaluating mental health concerns and conceptualizing the disorder in terms of a biopsychosocial framework.

Long‐term Follow‐up of Adolescents Treated for Rumination Syndrome in an Inpatient Setting

“…Treatment approaches for adolescents with RS have focused primarily on modification of the rumination behavior. Employment of behavioral approaches has resulted in several reports documenting short-term improvement, with immediate post-treatment outcomes reported such as global improvement (2,3), reduction in the frequency of the rumination behavior (4)(5)(6), improvements in caloric intake, and discontinuation of supplemental feedings (7).…”

Intensive Outpatient Treatment of Pediatric Rumination Syndrome

“…Discussion about anxiety in regard to Rumination syndrome is also useful. Some patients have premorbid anxiety that was more general, while others report only developing anxiety related to eating and vomiting after developing Rumination syndrome (Alioto et al, 2015). Some patients deny any experience of anxiety.…”

“…A recent review acknowledges the low prevalence rates of Rumination syndrome likely due to underdiagnosis, but reports 0%–5.1% prevalence in population studies of patients 5 years of age and older (Martinez et al, 2021). Rumination syndrome is often associated with a number of physical and psychological consequences including weight loss, food refusal, dehydration, significant anxiety, depression, social isolation, and decreased quality of life (Alioto et al, 2015; Chial et al, 2003).…”

Rumination Syndrome in Children and Adolescents: A Mini Review

“…While some patients may experience resolution of rumination following a basic introduction of competing responses such as diaphragmatic breathing, a significant proportion will continue to have on-going symptoms or experience relapse. This is particularly true for those with co-morbid anxiety or depression and when experiencing stress ( 43 , 48 ). Most patients will be better served by an interdisciplinary team consisting of a medical provider, a mental health provider, and often a dietician, particularly in the setting of weight loss.…”