rumination syndrome , or Merycism , is a less diagnosed undiagnosed chronic motility characterized by unnecessary regurgitation of most foods after consumption, due to muscle involuntary contraction around the abdomen. No vomiting, nausea, heartburn, odor, or abdominal pain associated with regurgitation, such as those present with regular vomiting. This disorder has historically been documented to affect only infants, young children, and people with cognitive disabilities (prevalence as high as 10% in patients instituted with mental disabilities). Today it is diagnosed in increasing the number of healthy adolescents and adults, despite the lack of awareness of the condition by doctors, patients and the general public.
The ruminating syndrome arises in many ways, with a very high contrast between the typical adult presentation without mental disability and the presentation of an infant and/or a person with a mental disorder. As with related gastrointestinal disorders, contemplation can affect normal functioning and individual social life. It has been linked to depression.
Little comprehensive data on the syndrome of ruminations in healthy individuals exists because most sufferers are personal about their illness and are often misdiagnosed because of the number of symptoms and clinical similarities between rumination syndrome and other disorders of the stomach and esophagus, such as gastroparesis and bulimia. nervosa. These symptoms include erosion caused by esophageal acid and enamel, halitosis, malnutrition, severe weight loss and unsatisfied appetite. Individuals may begin regurgitation within a minute of consumption, and a full cycle of consumption and regurgitation may mimic binging and bulimia cleaning.
The diagnosis of rumination syndrome is non-invasive and based on individual history. Treatment is promising, with over 85% of individuals responding to treatment positively, including infants and mentally disabled.
Video Rumination syndrome
Signs and symptoms
While the number and severity of symptoms vary among individuals, recurrent regurgitation of undigested food (known as rumination) after the onset of eating is always present. In some individuals, small regurgitation occurs long after swallowing, and can be recharged and swallowed. On the other hand, the number can be volatile and short, and must be excluded. While some only experience symptoms after several meals, most experience episodes after any consumption, from one bite to a large party. However, some long-term patients will find certain foods or drinks that do not trigger a response.
Unlike regular vomiting, regurgitation is usually described as easy and not coercive. There is rarely nausea before expulsion, and the undigested food lacks the bitter taste and smell of gastric acid and bile.
Symptoms can begin to manifest at any point from food consumption up to 120 minutes later. However, the more common range is between 30 seconds to 1 hour after the completion of the meal. Symptoms tend to stop when content is contemplated into acid.
Abdominal pain (38.1%), lack of fecal or constipation (21.1%), nausea (17.0%), diarrhea (8.2%), bloating (4.1%), and tooth decay (3 , 4%) is also described as a common symptom in everyday life. These symptoms are not always common during episodes of regurgitation, and can occur at any time. Weight loss is often observed (42.2%) at an average loss of 9.6 kilograms, and is more common in cases where the disorder is not diagnosed for longer periods of time, although this may be expected from nutritional deficiencies that often accompany disorder as a consequence of its symptoms. Depression is also associated with rumination syndrome, although its effect on rumination syndrome is unknown.
Erosion of acid in the teeth can be a hallmark of rumination, as can halitosis (bad breath).
Maps Rumination syndrome
Cause
The cause of rumination syndrome is unknown. However, studies have drawn a correlation between the hypothesized cause and the history of patients with the disorder. In infants and cognitive impairment, the disease is usually associated with excessive stimulation and lack of stimulation from parents and caregivers, causing individuals to seek self-satisfaction and self-stimulation due to lack or amount of external stimuli. These disorders are also often associated with disease attacks, past stress periods of recent individuals, and changes in treatment.
In adults and adolescents, the hypothesized causes generally fall into one of the categories both: induced habits, and induced trauma. Individuals induced by habit generally have a history of bulimia nervosa or deliberate regurgitation (a professional magician and regurgitator, for example), which, although initially caused by themselves, form a subconscious habit that can continue to manifest itself outside the control of the affected individual. Individuals induced by trauma describe emotional or physical injuries (such as recent surgery, psychological distress, concussion, death in the family, etc.), which precede the onset of reflection, often months.
Pathophysiology
The rumination syndrome is a poorly understood disorder, and a number of theories have speculated the mechanisms that cause regurgitation, which is a unique symptom for this disorder. Although no theories are consensual, some are more important and widely publicized than others.
The most documented mechanism is that food consumption causes gastric distension, followed by abdominal compression and simultaneous relaxation of the lower esophageal sphincter (LES). This creates a common cavity between the stomach and oropharynx that allows partially digested ingredients to return to the mouth. There are several explanations offered for sudden LES relaxation. Among these explanations is that it is the voluntary relaxation learned, which is common to those with or experiencing bulimia. While this relaxation may be voluntary, the overall process of rumination is still largely unintentional. Relaxation due to intraabdominal pressure is another proposed explanation, which will make the compression of the stomach the main mechanism. The third is the adaptation of the burping reflex, which is the most commonly described mechanism. Swallowing the air immediately before regurgitation leads to the activation of the burping reflex that triggers the relaxation of LES. Patients often describe feelings that are similar to the beginnings of a preliminary belch before.
Diagnosis
The ruminating syndrome is diagnosed based on the individual's full history. Expensive and invasive studies such as gastroduodenal manometry and esophageal Physiology tests are not needed and will often help in misdiagnosis. Based on typically observed features, several criteria have been suggested for the diagnosis of rumination syndrome. The main symptom, freshly digested food regurgitation, should be consistent, occurring for at least six weeks from the last twelve months. Regurgitation should begin within 30 minutes after completion of the meal. The patient may chew the vomiting material or remove it. The symptoms should stop within 90 minutes, or when the regurgitant material becomes acidic. Symptoms should not result from mechanical obstruction, and should not respond to standard treatment for gastroesophageal reflux disease.
In adults, the diagnosis is supported by the absence of classic or structural disease in the gastrointestinal system. Supporting criteria include non-acidic or acidic regurgitation, generally odorless, volatile, or most preceded by a burping sensation, that there is no retching before regurgitation, and that this action is not associated with nausea or heartburn.
Patients visited an average of five doctors over 2.75 years before being correctly diagnosed with rumination syndrome.
Differential diagnosis
The syndrome of ruminations in adults is a complex disorder whose symptoms can mimic some other gastroesophogeal disorders and diseases. Bulimia nervosa and gastroparesis mainly occur between misinterpretation.
Bulimia nervosa, among adults and especially adolescents, is by far the most common misdiagnosis sufferer to be heard during their experience with rumination syndrome. This is due to the similarity of symptoms to outside observers - "vomiting" after food intake - which, in long-term patients, may include ingesting excessive amounts to compensate for malnutrition, and a lack of willingness to expose their condition and symptoms. Although it has been suggested that there is a relationship between annihilation and bulimia, unlike bulimia, self-generating ruminations. Adults and teenagers with rumination syndrome are generally well aware of their nutritional deficiencies gradually, but can not control the reflexes. In contrast, people with bulimia deliberately induce vomiting, and rarely swallow food.
Gastroparesis is another common diagnosis. Like rumination syndrome, patients with gastroparesis often carry food after food consumption. Unlike ruminations, gastroparesis causes vomiting (in contrast to regurgitation) of food, which is not digested further, from the stomach. This vomiting occurs several hours after ingestion, preceded by nausea and vomiting, and has a bitter or sour taste typical of vomiting.
Classification
The rumination syndrome is a condition that affects the function of the stomach and esophagus, also known as functional gastroduodenal disorder. In patients with a history of eating disorders, Rumination syndrome is grouped with eating disorders such as bulimia. and pica, which themselves are grouped in non-psychotic mental disorders. In most adolescents and healthy adults who do not have mental disabilities, rumination syndrome is considered a motility disorder rather than an eating disorder, as patients tend to have no control over the incidence and have no history of eating disorders.
Treatment and prognosis
There is currently no known cure for contemplation. Proton pump inhibitors and other drugs have been used for little or no effect. Treatment is different for infants and mentally disabled than for adults and adolescents with normal intelligence. For adults and adolescents, Biofeedback and relaxation techniques, to practice after meals or whenever regurgitation occurs, have proved most effective. Among infants and those with mild mental disorders, behaviors, and light hostile exercises have been shown to lead to an increase in many cases. Aversive training involves associating behaviors contemplating with negative outcomes, and appreciating good behavior and eating. Putting a sour or bitter taste on the tongue when individuals initiate a movement or a distinctive breathing pattern from their reflective behavior is a generally accepted method for hostility training, although some older studies advocate the use of pinching. In patients with normal intelligence, rumination is not a deliberate behavior and is usually reversed using diaphragmatic breathing to resist the urge to vomit. Along with assurance, explanation and reversal of habits, patients are shown how to breathe using their diaphragms before and during the period of normal contemplation. A similar breathing pattern can be used to prevent normal vomiting. Breathing in this method works by preventing the physical contractions of the abdomen needed to remove the entrails.
Supportive therapy and diaphragmatic respiration have been shown to cause an increase in 56% of cases, and a total cessation of symptoms in an additional 30% in one study of 54 adolescent patients who were followed 10 months after initial treatment. Patients who successfully use this technique often notice changes in health that soon get better. Individuals who have experienced bulimia or who deliberately induce vomiting in the past have a reduced chance of improvement due to strengthened behavior. This technique is not used in infants or small children because of the time and complex concentration required to succeed. Most babies grow from a year of annoyance or with an unpleasant training.
Epidemiology
Formulation disorders originally documented as affecting newborns, infants, children and individuals with mental and functional disabilities (cognitive defects). Since then it has been recognized to occur in men and women of all ages and cognitive abilities.
Among the latter, it is illustrated with almost the same prevalence among infants (6-10% of the population) and adults instituted (8-10%). In infants, it usually occurs at the age of the first 3-12 months.
The occurrence of rumination syndrome in the general population has not been determined. Rumination is sometimes described as rare, but it has also been described as not rare, but rarely acknowledged. This disorder has female dominance. The typical age of adolescent onset was 12.9, giving or taking 0.4 years (Ã, Â ±), with males exposed more rapidly than females (11.0 Ã, Â ± 0.8 for males versus 13, 8 Â ± 0.5 for women).
There is little evidence of the effects of hereditary influences in rumination syndrome. However, case reports involving the whole family with rumors exist.
History
The term rumination is derived from the Latin ruminare , which means to chew the hump . First described in ancient times, and mentioned in the writings of Aristotle, the syndrome of rumination was clinically documented in 1618 by the Italian anatomist Fabricus ab Aquapendende, who wrote about the symptoms in his patients.
Among the earliest cases of rumination was a physician in the nineteenth century, Charles-ÃÆ' â € ° douard Brown-SÃÆ' Â © quard, who gained the conditions as a result of his own experiments. As a way of evaluating and testing gastric acid responses to various foods, doctors will swallow sponges bound to ropes, then deliberately vomit them to analyze their contents. As a result of this experiment, the doctor finally regurgitated his food regularly with reflexes.
Many case reports existed before the 20th century, but were strongly influenced by the methods and thoughts used at the time. At the beginning of the 20th century, it became clear that ruminations arose in various ways in response to conditions. Although still regarded as a disorder in infancy and cognitive defects at the time, differences in presentations between infants and adults were established.
Studies of contemplation in healthy adults became increasingly rare in the 1900s, and the majority of published reports analyzing the syndrome in mentally healthy patients emerged thereafter. Initially, adult predictions are described and treated as benign conditions. Now described as the opposite. While the patient base for examination has increased gradually as more and more people come forward with their symptoms, awareness of the condition by the medical community and the general public is limited.
In other animals
Chewing kati by animals such as cows, goats, and giraffes is considered normal behavior. These animals are known as ruminants. Such behavior, though called rumination, is not associated with the syndrome of human inflammation, but is normal. Unconscious contemplation, similar to what is seen in humans, has been explained to gorillas and other primates. True merycism, as opposed to the chewing process in ruminants, is also a normal part of the digestive process in some other animals, such as kangaroos.
See also
- Professional regurgitator
References
Children's Hospital of Philadelphia
External links
- MayoClinic.org Pediatrics - Rumination Syndrome - The Mayo Clinic website provides a clear and concise description of the disorder.
- WedMD - Rumination Disorder - MD Web. Provides an overview of the disease.
- Rumination Disorder - The Meadows Ranch Provides a clear picture of the disorder.
Source of the article : Wikipedia
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