Global Prevalence and Impact of Rumination Syndrome

Axel Josefsson,1 Jóhann P. Hreinsson,1 Magnus Simrén,1,2 Jan Tack,1,3
Shrikant I. Bangdiwala,4,5 Ami D. Sperber,6 Olafur S. Palsson,2 and Hans Törnblom1

1Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg,
Gothenburg, Sweden; 2Center for Functional GI and Motility Disorders, University of North Carolina-Chapel Hill, Chapel Hill,
North Carolina; 3Translational Research Center for Gastrointestinal Disorders (TARGID), Department of Chronic Diseases,
Metabolism and Aging (CHROMETA), KU Leuven, Leuven, Belgium; 4Department of Health Research Methods, Evidence, and
Impact, McMaster University, Hamilton, Ontario, Canada; 5Population Health Research Institute, McMaster University,
Hamilton, Ontario, Canada; and 6Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel

BACKGROUND & AIMS: Rumination syndrome is a Disorder of Gut-Brain Interaction (DGBI) of unknown etiology. We aimed to assess its global prevalence and potential associations with other medical conditions. METHODS: Data were collected via the Internet in 26 countries. Subjects were evenly distributed by country, sex, and age groups and were invited for a “health survey” using the Rome IV diagnostic questionnaire and a supplementary questionnaire addressing factors potentially
associated with DGBI. RESULTS: In all, 54,127 subjects completed the survey (51% male; mean age, 44.3 years). The overall prevalence of rumination syndrome was 3.1% (95% confidence interval [CI], 3.0–3.3%). It was highest in Brazil (5.5% CI, 4.5–6.5) and lowest in Singapore (1.7% CI, 1.1–2.2).
The mean age of people with rumination syndrome was 44.5 years (standard deviation, 15.6) and it was more common in females (54.5% vs 45.5%). Factors independently associated with rumination syndrome were depression (odds ratio [OR], 1.46), anxiety (OR, 1.8), body mass index (OR, 1.04), and female sex (OR, 1.19). Subjects with multiple DGBI were at increased risk of having rumination syndrome, with the highest risk in subjects with 4 gastrointestinal regions with DGBI (OR, 15.9 compared with none). Quality of life (QoL) was lower in subjects with rumination syndrome compared with the rest of the cohort (PROMIS-10 score: physical QoL mean 12.9 vs 14.5; mental QoL mean 12.0 vs 13.6). CONCLUSIONS: The prevalence of rumination syndrome is higher than reported in most previous
population studies and is likely underdiagnosed in clinical practice. Awareness of rumination syndrome should be raised among clinicians to improve care for these patients.