Systematic Review
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Meta-Anal. Jun 30, 2019; 7(6): 297-308
Published online Jun 30, 2019. doi: 10.13105/wjma.v7.i6.297
Treatment options for rumination syndrome: A systematic review
Andrew Ming-Liang Ong, Shu-Wen Tay, Yu-Tien Wang
Andrew Ming-Liang Ong, Shu-Wen Tay, Yu-Tien Wang, Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore 169856, Singapore
Andrew Ming-Liang Ong, Yu-Tien Wang, Duke-NUS Graduate Medical School, Singapore 169856, Singapore
Author contributions: Ong AML wrote the manuscript and performed the research. Wang YT and Tay SW performed the research and contributed to the editing of the manuscript. All authors have approved the final version of the manuscript. The manuscript is original work of author. All data, tables, figures, etc. used in the manuscript are prepared originally by authors, otherwise the sources are cited and reprint permission should be attached.
Conflict-of-interest statement: The authors have no conflict of interest to declare.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Andrew Ming-Liang Ong, MBChB, MRCP, Assistant Professor, Doctor, Department of Gastroenterology and Hepatology, Singapore General Hospital, 20 College Road, Level 3, Academia Building, Singapore 169856, Singapore.
Telephone: +65-6321-4684 Fax: +65-6227-3623
Received: April 22, 2019
Peer-review started: April 23, 2019
First decision: May 24, 2019
Revised: May 31, 2019
Accepted: June 10, 2019
Article in press: June 10, 2019
Published online: June 30, 2019

Rumination syndrome (RS) is characterized by recurrent effortless postprandial regurgitation of recently ingested food from the stomach to the oral cavity and has been associated with quality of life impairment and malnutrition. There is a general lack of consensus on the most appropriate treatment options for RS.


To summarize the literature on treatment options for RS.


We conducted a systematic review according to PRISMA guidelines. We searched Medline (1946 to February 2019), EMBASE (1947 to February 2019), PsycINFO (1806 to February 2019) and Cochrane central register of controlled trials for articles discussing treatment options for adult patients (> 18 years) with RS. All relevant articles were accessed in full text. We extracted data on study designs, patient profiles, duration of symptoms, follow up periods, date, diagnostic criteria, interventions and outcomes. Risk of bias assessment was carried out independently by 3 reviewers via Cochrane Risk of Bias tool and Newcastle Ottawa Scale for randomized controlled trials and Cohort studies respectively.


Twelve articles were identified. A total of 254 patients were included in the analysis, with a mean age of 36.1 (range 18-89). 185 patients (72.8%) were females. 5 studies looked into behavioral therapies, primarily diaphragmatic breathing (DB) 2 studies looked at baclofen, 1 fundoplication and 1 supportive lifestyle changes. 3 studies looked at a combination of therapies involving pharmacological, behavioral and psychotherapies.


Although evidence for treatment options is still limited, the strongest evidence point towards the use of DB and Baclofen, and both should be considered depending on their availabilities.

Keywords: Rumination, Rumination syndrome, Diaphragmatic breathing, Treatment, Systematic review

Core tip: Rumination syndrome (RS) is a relatively common but underdiagnosed gastroenterological condition. Due to recent advances in research, we have decided to perform the first systematic review on treatment options for RS. Our results show that diaphragmatic breathing has the strongest data for efficacy in this condition.