Rumination

RUMINATION (ruminatio, merycismus), the regurgitation of small portions of swallowed food back into the oral cavity and its subsequent re-chewing and re-swallowing, similar to the process that occurs in ruminant animals. Rumination was described in humans as early as the 17th century by Fabricius ab Aquapendente. It occurs in adults and children, especially in the age range from 1 to 3 years; it is 8 times more frequent in men than in women (Bushuev) and sometimes presents as a familial phenomenon, especially in families that are degenerate or psychiatrically burdened. Rumination is often linked to disorderly, hurried eating and poor chewing of food. Rumination differs from vomiting in its ease, the small quantities of food ejected, and, most importantly, the absence of nausea. The general condition of the patient is little affected. Anatomical data on rumination are poorly studied; often, in this regard, as well as in the chemistry of digestion, no changes are found. Views regarding the mechanism of rumination still diverge. According to some, the matter boils down to the fact that, as in vomiting, after a deep inspiration and closure of the larynx, food is moved upward through the relaxed cardia due to the tension of the diaphragm and the muscles of the abdominal wall. According to others, active tension of the diaphragm, abdominal walls, and stomach during regurgitation does not take place, and the entire process consists only of a purely passive aspiration of food from the stomach upon closure of the larynx after a deep inhalation. Some consider paresis of the cardia to be a very significant factor in the emergence of rumination. Some importance is also attributed to antiperistaltic movements of the esophagus. Rumination is observed especially in the mentally deficient. However, it can also occur in neuropathies; it has been described relatively frequently in hysteria and psychasthenia (obsessive state). Sometimes rumination unexpectedly ceases under the influence of one or another neuropsychic impulse (for example, suggestion), which is why most authors classify it as a neurosis of the digestive tract, and one that carries a good prognosis. Among therapeutic measures, one should point to the systematic training of patients to voluntarily suppress regurgitation, the prohibition of drinking during meals, and the advice to perform expiratory movements after eating, which should suppress the inspiration that plays such a large role in the act of regurgitation. Children suffering from habitual vomiting (or even without it) sometimes acquire the habit of regurgitating food into the mouth after eating and then begin to perform movements with the lower jaw and tongue that resemble chewing. Often they perform such regurgitation voluntarily, inducing gagging movements in themselves or by sticking their fingers into their mouths. Then, with visible pleasure, they re-swallow the food regurgitated into the mouth. Rumination occurs in children with a neuropathic constitution and most often under the monotonous conditions of closed institutions, during bed rest, as a result of which it is classified by many as a phenomenon of stereotypical movements based on a habitual reflex and hospitalism (see), along with body rocking, thumb sucking, masturbation, etc. Properly implemented upbringing of the child or a change in living conditions easily eliminates this phenomenon.