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Rumination syndrome: when to suspect and how to treat. PURPOSE OF REVIEW: Rumination syndrome is a gastrointestinal disorder characterized by effortless regurgitation of recently ingested food. The disorder is rare, but likely under-recognized and leads to impaired quality of life among those affected. This review discusses recent studies which examined the pathophysiology, diagnoses and therapy of rumination syndrome. RECENT FINDINGS: The pathogenesis of rumination syndrome remains incompletely understood. Therapeutic options, which appear effective, include behavioral therapy with diaphragmatic breathing and pharmacotherapy with baclofen. A randomized trial of behavioral therapy, biofeedback therapy led to a 74% + /- 6% reduction in rumination activity (from 29 + /- 6 before to 7 + /- 2 daily events after intervention) vs. 1% + /- 14% during sham (from 21 + /- 2 before to 21 + /- 4 daily events after intervention) (P = .001). A recent randomized trial of baclofen at a dose of 10 mg three times daily led to symptomatic improvement in 63% of patients with rumination syndrome. SUMMARY: This review summarizes a clinical approach to diagnosing and treating rumination syndrome. Behavioral therapy consisting of diaphragmatic breathing, with or without biofeedback, remains the most effective treatment strategy for patients with rumination syndrome.