Eating Disorders and Other Psychiatric Disorders May Increase Risk for Rumination Syndrome

Researchers examined whether having a medical history of an eating disorder or other psychiatric disorder increased the risk for rumination syndrome.

The prevalence of eating disorders and psychiatric disorders is significantly higher in patients with rumination syndrome (RS) compared with control individuals, according to study results published in the Journal of Clinical Gastroenterology.

The retrospective case-control study included adult patients diagnosed with RS from 2013 to 2018 at a tertiary care center. RS was defined from clinical history with a gastroenterologist or with objective high-resolution impedance-esophageal manometry testing. For each RS case, 2 age- and sex-matched control individuals were identified.

A total of 72 patients were included (24 RS cases and 48 control individuals) in the study. The overall mean age was 25.9±14.2 years, 62.5% were women, and the mean body mass index was 25.7±7.6 kg/m2.

Among the patients with RS, 37.5% had a history of eating disorders, including 12.5% with anorexia nervosa, 16.7% with bulimia nervosa, and 8.3% with food avoidance (FA). Patients with RS had a higher total prevalence of eating disorders (37.5% vs 4.2%, P =.0002), compared with matched control individuals. A trend was observed toward a greater frequency of FA in RS patients (8.3% vs 2.1%, P =.21), but it did not reach statistical significance.

Among patients with eating disorders, 81.8% were diagnosed with at least 1 other psychiatric disorder, a higher rate than in those without eating disorders ( 57.4%), although it was not statistically significant (P =.13).

In the RS group, 83.3% of patients were diagnosed with a psychiatric disorder, including 37.5% with anxiety, 29.2% with depression, 8.3% with obsessive-compulsive disorder, 8.3% with post-traumatic stress disorder, 4.2% with bipolar affective disorder, and 12.5% with other disorders.

The combined group of other disorders (adjustment disorder, body dysmorphic disorder, and premenstrual dysmorphic disorder) was more prevalent in patients with RS vs control individuals (12.5% vs 0%, P =.012).

Multivariable analysis showed that eating disorders (adjusted odds ratio [aOR], 16.4; 95% CI, 2.54-105.3; P =.0033) and psychiatric disorders (aOR, 4.47; 95% CI, 1.17-17.1; P =.029) remained independent risk factors for RS.

Study limitations include the small, retrospective cohort from a single tertiary center. In addition, patients with eating disorders and psychiatric disorders were identified through electronic chart review and may have been under-reported, and it is possible that the selected controls could be misclassified, owing to the overlap between gastroesophageal reflux disease and RS.

“Our results suggest that clinicians should have a high index of suspicion for RS in patients with a history of eating disorders or psychiatric disorders who present with intractable vomiting, reflux, or regurgitation,” the study authors commented. “Moreover, any evaluation of RS should include a detailed and comprehensive history for both eating disorders and psychiatric disorders.”


Cai JX, Wong D, Lee DJH, Chan WW. Eating and psychiatric disorders are independent risk factors for rumination syndrome. J Clin Gastroenterol. 2022;56(3):228-233. doi:10.1097/MCG.0000000000001510