Treatment options for rumination syndrome: A systematic review

Table 3 Suggested approach in treatment of rumination syndrome

Condition	Treatment
Initial treatment	Extensive explanation of condition and underlying mechanism together with reassurance of benign nature of condition[2,20]
	Diaphragmatic breathing by trained personnel (with EMG guidance or HRiM if available)
	If no response to diaphragmatic breathing after ensuring compliance, Baclofen 5-10 mg three times daily
For refractory cases	Consider alternative diagnosis (GERD, gastroparesis, functional dyspepsia, supragastric belching) and treat appropriately
	Since both DB and baclofen appear to be effective and work via different mechanisms, we postulate that a switching to the other therapy or a combination of these therapies could be useful in cases refractory to either treatments
	Address psychological illness, if present. Consider adjunctive psychological therapies to correct cognitive processes that may perpetuate symptoms

EMG: Electromyography; GERD: Gastroesophageal reflux disease; DB: Diaphragmatic breathing.