Pica and rumination disorder — structured clinical viva

This is adult rumination disorder (rumination syndrome): chronic effortless meal-linked regurgitation with rechewing/reswallowing, failed acid suppression, normal endoscopy, and absent BN body-image drive. Anxiety may coexist as a consequence or comorbidity but does not redefine the physiology.^[1][5]

Versus GORD. Heartburn-predominant acid disease often responds at least partially to PPI; rumination is mechanical effortless regurgitation soon after meals, often with reswallowing. Endoscopy may be normal in both — history is decisive.^[1][5]

Versus BN. No binge, no fat phobia, no shape overvaluation — do not force BN therapy targets. If those emerge later, dual formulate.^[1]

Mechanism and treatment. Abdominothoracic strain → raised gastric pressure → LES relaxation → effortless regurgitation. First-line: education + diaphragmatic breathing competing with the strain pattern; evidence supports mechanism and clinical use.^[1][2] Biofeedback has RCT support for reducing episodes.^[3] Baclofen 10 mg orally three times daily has RCT support in refractory disease as adjunct — discuss side effects and specialist framing; not a magic sole tablet that replaces behavioural work.^[4]

GI re-involvement. Red flags, diagnostic uncertainty, or refractory course → consider high-resolution manometry with impedance and joint management.^[1][5] PARDI can structure feeding-disorder assessment when presentations are mixed with ARFID/pica features.^[6]