Outcomes of Treating Rumination Syndrome with a Tricyclic Antidepressant and Diaphragmatic Breathing

Background: Rumination syndrome is a functional gastrointestinal disorder characterized by effortless postprandial regurgitation and accompanied by gastric visceral hypersensitivity. Almost invariably, the onset of symptoms is preceded by a psychologically stressful situation, and anxiety is often an accompanying complaint. In this background of gastric visceral hypersensitivity, anxiety and psychological stress, we investigated the effectiveness of combining a tricyclic antidepressant (TCA) with diaphragmatic breathing/relaxation techniques for the treatment of rumination syndrome.

Materials and methods: Patients who fulfilled the Rome IV criteria for rumination syndrome received hands-on instructions and/or coaching on diaphragmatic breathing techniques, were given relaxing auditory media, started on a TCA, and completed a follow-up symptoms questionnaire after undergoing a minimum of 3 months of this therapy.

Results: A total of 44 patients, 35 women; mean age 40.4 (range 20-71) were identified. Mean time from onset of symptoms to diagnosis was 36.0 months (range 6-180). Weight loss ranged from 1.4 to 39.5 kg. Approximately 65.9% had a history of anxiety and/or depression, and a separate 65.9% reported the onset of symptoms were chronologically related to an inciting event and/or psychological stressor. After a mean follow-up period of 8.8 months, 90.9% of patients reported improvement in their symptoms, with a mean subjective improvement from baseline of 68.9%, and specifically, 45.5% of patients reported ≥80% improvement. Weight increased or stabilized in 80.6% of those initially reporting weight loss.

Conclusions: The combination of a TCA with diaphragmatic breathing/relaxation techniques is an effective treatment modality for the management of rumination syndrome as it addresses the underlying factors identified in this entity.