Chronic vomiting and diarrhea in a young adult female

Patient: Female, 25 Final Diagnosis: Rumination syndrome Symptoms: Diarrhea • nausea • vomiting Medication: — Clinical Procedure: — Specialty: Psychology OBJECTIVE: Rare disease BACKGROUND: Rumination syndrome is a behavioral disorder that consists of an effortless regurgitation of undigested food that is subsequently either re-swallowed or ejected within minutes of meal ingestion occurring with liquids and solids. It was first described in children that are mentally disadvantaged but has gained more attention to also occur among both adolescents and adults of normal mental capacity. The prevalence has never accurately been assessed due to its rarity and frequent misdiagnosis. CASE REPORT: A 25-year-old Caucasian female presented to our care with a chronic history of nausea, vomiting and diarrhea. She has vomited during the postprandial period for the last four years. She also has much as ten bouts of diarrhea per day. There is no definitive evidence of chronic laxative use or self-induced vomiting. Physical examination had no significant findings except a cachectic female patient with a BMI of 16 and hypotension. Patient was eventually discharged home with nutrition recommendations for nocturnal psychology follow up for relaxation behavioral techniques. CONCLUSIONS: Due to its elusiveness rumination syndrome is both underdiagnosed and a misdiagnosed condition. One of the reasons for a delayed diagnosis in patients with rumination syndrome is that many physicians are unaware of it, or are even reluctant to make this diagnosis as it could easily be confused with an eating disorder or with other gastrointestinal motility disorders. Because this syndrome may be left undiagnosed for months to years, patients often undergo many expensive and invasive procedures.