{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,22]],"date-time":"2026-04-22T21:37:38Z","timestamp":1776893858853,"version":"3.51.2"},"reference-count":30,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2012,11,22]],"date-time":"2012-11-22T00:00:00Z","timestamp":1353542400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Aliment Pharmacol Ther"],"published-print":{"date-parts":[[2013,1]]},"abstract":"<jats:title>Summary<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Rumination is the voluntary, albeit subconscious return of gastric contents to the mouth. Currently, rumination syndrome and repetitive belching disorders are considered separate diagnoses, as defined by Rome III criteria and high\u2010resolution oesophageal manometry (<jats:styled-content style=\"fixed-case\">HRM<\/jats:styled-content>).<\/jats:p><\/jats:sec><jats:sec><jats:title>Aim<\/jats:title><jats:p>To test the hypothesis that these conditions represent a common behavioural response to aversive digestive stimuli and that successful treatment can be directed at both the stimulus and the response.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Case\u2010note review of consecutive patients with a final diagnosis of behavioural digestive disorders between August 2009 and October 2011.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Thirty\u2010five of 46 (76%) patients exhibited \u2018classical\u2019 rumination with abdomino\u2010gastric strain (R\u2010waves) driving gastric contents across the lower oesophageal sphincter; 5 (11%) had \u2018reflux\u2010related\u2019 rumination with R\u2010waves seen during gastro\u2010oesophageal common cavity (reflux) events and 6 had (13%) supra\u2010gastric belching. All received at least one biofeedback session at the time of diagnosis with a good response reported by 20\/46 (43%) of the patients, which included 3 with supra\u2010gastric belching. Additionally, rumination ceased in cases in which definitive treatment relieved the symptoms that triggered abnormal behaviour (e.g. fundoplication in \u2018reflux\u2010rumination\u2019).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Rumination and many of its variations, excluding only some cases of supra\u2010gastric belching, are associated with abdomino\u2010gastric strain, a generic abnormal behavioural response to a variety of aversive digestive stimuli. All types of rumination can respond to biofeedback. High\u2010resolution oesophageal\nmanometry identifies subgroups with distinct mechanisms of disease that respond to specific management targeted at the symptoms that trigger the abnormal behaviour.<\/jats:p><\/jats:sec>","DOI":"10.1111\/apt.12148","type":"journal-article","created":{"date-parts":[[2012,11,23]],"date-time":"2012-11-23T03:01:52Z","timestamp":1353639712000},"page":"263-274","source":"Crossref","is-referenced-by-count":101,"title":["Rumination variations: aetiology and classification of abnormal behavioural responses to digestive symptoms based on high\u2010resolution manometry studies"],"prefix":"10.1111","volume":"37","author":[{"given":"E.","family":"Tucker","sequence":"first","affiliation":[{"name":"NIHR Biomedical Research Unit in Gastrointestinal and Liver Diseases at Nottingham University Hospital NHS Trust and The University of Nottingham Nottingham UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"K.","family":"Knowles","sequence":"additional","affiliation":[{"name":"Nottingham University Hospitals NHS Trust, GI Motility Unit Division of GI Surgery Nottingham UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J.","family":"Wright","sequence":"additional","affiliation":[{"name":"Nottingham University Hospitals NHS Trust, GI Motility Unit Division of GI Surgery Nottingham UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M. 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