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The Rome IV criteria for rumination syndrome are given in Table 4.1 [1]. In addition to these criteria, several other typical manifestations are noted [2]. For example, patients are often as likely to regurgitate liquids and solids without relation to the volume consumed. Many patients are not bothered by the symptoms and learn to effectively hide the regurgitation and re‐mastication from others even while sharing a meal. Weight loss occurs in approximately half of patients [3]. In its most severe form, patients may have profound weight loss and dehydration, but search for an additional cause of symptoms in these patients should be sought. Patients commonly have a vague sense of when the regurgitation is starting, which may be during to a few hours after the meal [1, 4]. In most patients, the regurgitation occurs within 30 minutes of finishing a meal. Finally, rumination occurs with almost, if not, every meal and may or may not be volume related.

Rumination was first described in children with developmental disabilities but has since been expanded to include children and adults with normal intelligence [3, 5]. Although often ascribed to individuals with psychiatric illnesses, this is not applicable to many patients. There is little data on the prevalence of rumination syndrome. Two studies based on population‐based data have reported prevalences of 0.8 and 0.9% [6, 7]. This data likely underestimates the true prevalence due to confusion with other esophageal disorders and under‐recognition by physicians. It appears to be more common in certain subsets of patients such as children and teenagers [3, 8], young adults, and patients with fibromyalgia [9]. Interestingly, the geographic distribution of rumination syndrome appears to be worldwide and may occur in patients of all ages, races, and gender.