Manometric Study of a Ruminator

Rumination is an uncommon disorder with controversial pathophysiology. We have studied a classic ruminator with esophageal, gastric, and small bowel motility techniques during episodes of voluntary regurgitation. His regurgitation was accompanied by 1) simultaneous positive pressure deflections in multiple locations in the stomach, 2) simultaneous negative pressure deflections in multiple locations in the esophagus followed rapidly by simultaneous positive pressure deflections, 3) brief (1-second) periods of lower esophageal sphincter relaxation, and 4) deep inspiratory movements. No intrinsic abnormalities of esophageal, gastric, or small bowel motility were present. We conclude that regurgitation in a ruminator is triggered by a Mueller experiment (forced inspiration against a closed glottis).