Erosive Eosinophilic Esophagitis in Rumination Syndrome

Rumination syndrome involves bringing up partially digested food into the pharynx voluntarily, followed by reswallowing or expelling. It was discovered in the 17 century; however, knowledge of the disorder has remained sparse until recently. Indeed, the first case of adult rumination in Japan was reported as recently as 2006. Due to this recent increase in awareness, notions about the disease have remained in a state of constant fluctuation. While first believed to be a disease of neurologically-impaired children between 3 and 8 months of age, it is now widely recognized as occurring in men and women of all ages and cognitive abilities. Originally rumination was labeled benign; however, it is now known to cause such complications as weight loss, malnutrition, dental erosions, halitosis, electrolyte abnormalities, abdominal discomfort, weight loss, choking, aspiration, and pneumonia. Similarly, while the absence of gastroesophageal reflux disease was an original criterion for the syndrome, it has been found that many of these patients have evidence of “pathologic gastroesophageal reflux.” Some suggest that thorough upper gastrointestinal workup, such as upper esophageal barium studies and EGD, not be done on children presenting with rumination, despite the presence of abdominal pain or other accompanying gastrointestinal symptoms. We performed a thorough upper gastrointestinal workup on a patient with concurrent rumination syndrome and heartburn, and were intrigued by the findings.