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Medicine and Health

Learning Treatment to Suppress Rumination

Rumination is characterised by an effortless recurrent regurgitation of recently ingested food into the mouth, with consequent spitting and/or re-chewing and re-swallowing. A study with 28 patients detected the manoeuvre that causes regurgitation by measuring the electrical activity of the abdomen and chest muscles. Later, after seeing the records obtained, patients learned to control the activity of the muscles involved and achieved to supress rumination.

References

Barba, Elizabeth; Burri, Emanuel; Accarino, Anna; Malagelada, Carolina; Rodriguez-Urrutia, Amanda; Soldevilla, Alfredo; Malagelada, Juan-R.; Azpiroz, Fernando. Biofeedback-Guided Control of Abdominothoracic Muscular Activity Reduces Regurgitation Episodes in Patients With Rumination. Clinical Gastroenterology and Hepatology. 2015, vol. 13, num.1, p. 100-106. doi: 10.1016/j.cgh.2014.04.018.

Rumination is characterized by effortless recurrent regurgitation of recently ingested food into the mouth, with consequent spitting or re-chewing and swallowing. The implications of rumination range from relatively minor social inconvenience to severe nutritional problems.
 
In 28 patients with rumination we recorded the activity of the abdomino-thoracic muscles by means of electromyography before and after a meal. Patients were trained to modulate their muscular activity under visual control of the recordings.
 
Our study showed that regurgitation of the content of the stomach after the meal is produced by a coordinated abdomino-thoracic maneuver consisting of a sudden abdominal compression coupled with a thoracic suction (simultaneous contraction of the muscles of the abdomen and the thorax). Interestingly, this maneuver is usually unnoticed by the patients themselves and their proxies. Why ruminators inadvertently learned this response to feeding and which are the specific trigger of rumination events is not known. Interestingly, looking at the electromiographic tracings, patients were taught to control abdomino-thoracic muscular activity, and this was associated with the suppression of rumination.
 
In the present proof-of-concept study, a fairly complex methodology was applied, first, to identify the key mechanisms of rumination and, second, to test a targeted biofeedback treatment.  However, once the target and its effectiveness are proven, the procedure might be conceivably simplified for widespread application.     
 
Top left figure: Diagram of the process to suppress rumination.

Fernando Azpiroz

Department of Medicine

azpiroz.fernando@gmail.com