Oral expulsion syndrome-Rumination syndrome - Wikipedia

This systematic review is an evaluation of the empirical literature relating to the disordered eating behaviour Chew and Spit CHSP. Current theories postulate that CHSP is a symptom exhibited by individuals with recurrent binge eating and Bulimia Nervosa. The review aimed to identify and critically assess studies that have examined the distribution of CHSP behaviour, its relationship to eating disorders, its physical and psychosocial consequences and treatment. A systematic database search with broad inclusion criteria, dated to January was conducted. Data were extracted by two authors and papers appraised for quality using a modified Downs and Black Quality Index.

Oral expulsion syndrome

Oral expulsion syndrome

Oral expulsion syndrome

Oral expulsion syndrome

Oral expulsion syndrome

Sitemap Why an ED glossary? New York: Springer; Diagnosis of rumination syndrome is non-invasive and based on a history of the individual. Variable markers. You must not rely Beautiful sexy woman the information on this website as an Oral expulsion syndrome to medical advice from your doctor or other professional healthcare provider. Treatment experiences of males with expulzion eating disorder: A systematic review of qualitative studies. Pervasive refusal syndrome. Calorie counting. Nutritional Therapy. The chewing of cud by animals such as cows, goats, and giraffes is considered normal behavior.

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Reported causes for the syndrome include infarction of the cortex[ 45 ], operculum[ 6 ], corona radiata[ 7 ], posterior limb of the internal capsule[ 8 ], thalamus[ 9 ], or brainstem[ 1011 ]. In recent publications, there are three main streams of thought concerning COS: an association with uncommon intracranial cause, 78 concomitant uncommon neurological deficits, 910 and an increasing number of variants. Author information Copyright and License information Disclaimer. Int J Neurosci. Periodontium gingivaperiodontal ligamentcementumalveolus — Gums and tooth-supporting structures. Cheiro-oral-pedal syndrome. Her nerve conduction velocity study showed sensory axonopathy but magnetic resonance image did not reveal consistent abnormality. Author information Article notes Copyright and License information Disclaimer. I really do. There Oral expulsion syndrome no laboratory abnormalities or acute changes seen on non-contrast Skater boy porn CT. Oral expulsion syndrome onset was sudden and without prodrome approximately 6 hours prior to ED arrival. Conservation treatment was performed in another 5 patients.

Nausea encapsulates your body, but hunger remains.

  • After a century, cheiro-oral syndrome COS was harangued and emphasized for its localizing value and benign course in recent two decades.
  • I have struggled for years with my health and my goal is to help others in any way possible through my experiences!
  • Oral allergy syndrome OAS is a type of food allergy classified by a cluster of allergic reactions in the mouth and throat in response to eating certain usually fresh fruits , nuts , and vegetables that typically develops in adults with hay fever.

This systematic review is an evaluation of the empirical literature relating to the disordered eating behaviour Chew and Spit CHSP. Current theories postulate that CHSP is a symptom exhibited by individuals with recurrent binge eating and Bulimia Nervosa.

The review aimed to identify and critically assess studies that have examined the distribution of CHSP behaviour, its relationship to eating disorders, its physical and psychosocial consequences and treatment.

A systematic database search with broad inclusion criteria, dated to January was conducted. Data were extracted by two authors and papers appraised for quality using a modified Downs and Black Quality Index. Nine studies met the inclusion criteria.

No studies of treatment were found. Conclusions were limited due to the low quality and small numbers of studies based on clinical samples only. Further research is needed to address gaps in knowledge regarding the physiological, psychological, social, socioeconomic impact and treatment for those engaging in CHSP. Some people have a problematic weight control behaviour of chewing their food and spitting it out before swallowing, or Chew and Spit.

We searched all the scientific papers that we could find on Chew and Spit for information but there were only nine studies and they could not be relied upon because of poor scientific quality.

However, it seemed likely there was an association between Chew and Spit and eating disorders like anorexia nervosa. Studies of why people Chew and Spit, how it affects their health, and how to help them are needed. Chew and Spit CHSP is the pathological behaviour of chewing a food, often of subjectively enjoyable quality as well as dense caloric content, and then spitting it out before swallowing as a means to avoid ingesting unwanted calories [ 1 ].

CHSP is an understudied weight control method possibly used as a binge eating compensatory behaviour employed by individuals with an eating disorder ED. Many people also report disordered eating and ED behaviours pre and post bariatric surgery and it is likely that ED behaviours, including CHSP, are under reported and not detected during surgical assessments [ 7 , 9 — 11 ]. However, the psychological and physiological effects of CHSP have yet to be delineated in any population.

The physiological process of preparing to receive food, called the cephalic response, is linked to metabolic changes in the body. Some studies involving modified sham feeding have focused on specific hormones, such as insulin, obestatin, and ghrelin as part of the cephalic response [ 11 — 17 ].

However, few studies involving sham feeding do so in the context of disordered eating [ 18 — 21 ]. Nor do sham-feeding studies focus on behaviour and psychological phenomenology, with specific studies into the influence of CHSP on metabolic responses being non-existent [ 19 — 25 ].

Empirical studies into the aetiology, psychological impacts, and physiological outcomes of CHSP would offer insight into an understanding of such processes in individuals with broader EDs, diabetes, or who are prone to post-bariatric-surgery dumping the quick passage of food from the stomach to the small intestine [ 18 ]. Hypothesised outcomes of CHSP may include weight gain due to accidentally ingesting calories, psychological and emotional distress such as shame and guilt , and other physiological sequelae such as damage to teeth, stomach ulcers, and hormonal imbalances [ 6 — 9 ].

This systematic review aims to examine existing evidence, identify, and critically examine studies that have investigated the distribution of CHSP behaviour, its relationship to EDs, and physical and psychosocial consequences. As the literature is sparse, the search and eligibility criteria were broad.

The review also aims to identify gaps in the knowledge as, to date, little appears to be known about CHSP within and outside of EDs, including its prevalence, distribution, and putative harmful physical or psychological effects. Searches were conducted using key words and repeated using MeSH categories where applicable. References of included studies were manually screened by title.

The full text for any potentially eligible studies was sourced and assessed for eligibility. Only peer-reviewed studies were considered for inclusion to ensure data integrity and maintain quality.

Studies of non-human participants were excluded as were those pertaining to rumination and pica, which are categorized in the DSM-5 as two distinct disorders separate to CHSP [ 2 ]. CHSP is distinctive from rumination, which is the regurgitation of stomach contents that is either chewed and re-swallowed, or spat out; and can occur involuntarily — often seen in those with severe purging subtype eating disorders as a motivated and habitual behaviour — or voluntarily [ 27 ].

On the other hand, pica involves the ingestion of non-food items [ 27 ]. The definition of CHSP thus was limited to the conscious chewing and spitting out of food only without regurgitation of swallowed food.

As commonly seen in eating disorders, symptoms may overlap. However, studies were excluded if they did not focus on CHSP specifically or were related to regurgitation or chewing and spitting non-food items [ 27 ]. The two authors also assessed full-text articles to confirm that articles met to eligibility criteria. Disagreements were resolved through discussion, or referral to a third review author.

Flow diagram highlighting selection process of included articles [ 28 ]. Data regarding CHSP symptomology, prevalence, psychological, social, or physiological impacts were extracted from the included studies.

Data not directly related to CHSP were not included in the summary tables. The quality index excluded items specifically related to randomised controlled trials RCTs such as those items assessing randomisation, dropouts, blinding, and intervention integrity: none of the included studies were RCTs. This resulted in subscales assessing reporting 7 items , external validity 3 items , internal validity 4 items , and study power 1 item.

Of the studies identified, only nine met the eligibility criteria for inclusion in the systematic review — six cross-sectional studies, and three case studies. All were clinical samples and none representative of the treatment majority. Given the heterogeneity across studies, data are presented qualitatively. Ferro and speechley quality index scores for included studies [ 30 ].

Similarly, a cross-sectional study by Guarda et al. However, length of illness was not associated with this finding. There was no significant difference in in psychometric measures i. Makhzoumi et al. In a cross-sectional study, Kovacs et al. The majority In a cross-sectional study Mitchell et al. The authors posited that CHSP is used as a substitute for binging and purging or other bulimic behavioural patterns. When comparing individuals with BN who had low frequency CHSP to those with high frequency CHSP, there was no significant difference between these types of participants and a control group [ 1 ].

In total, the case studies report on four females aged between 19 and Similar themes between the reports highlight that CHSP was used as a weight-control method and was often associated with negative emotions such as self-disgust, remorse, and shame, but may have been be less distressing than binging and purging [ 33 , 37 , 39 ]. Additionally, because of CHSP, individuals appeared to have concerns over social, financial, and familial issues [ 33 , 37 , 39 ]. Only one study, by Smith and Ross [ 33 ] offered possible explanations for the CHSP behaviour, including avoiding feeling deprived, addiction transference, a stress response, or a deficiency in trace minerals or vitamins.

This systematic review identified nine studies that met the eligibility criteria [ 1 , 32 — 39 ]. Grey literature, clinical but non-academic sources, and other sources that did not meet the eligibility criteria were surveyed to generate plausible hypotheses and mechanisms for describing pathways and outcomes of CHSP.

The psychological, social, or physiological precursors or outcomes of the behaviour also remain unclear. Such referral bias could have given rise to higher numbers of participants with specific eating disorders than would sampling CHSP across the ED spectrum.

The quality of eligible studies was of concern as no RCTs were conducted to investigate responses to various treatment options for the disordered behaviour of CHSP. Overall, the included studies did not provide deep insight into the wider prevalence and consequences of CHSP. Both Durkin et al. Smith and Ross [ 33 ] presented a case study on CHSP symptomology in a patient who was not diagnosed with an ED but who turned spontaneously to the behaviour during a period of extreme calorie and nutrient deprivation akin to that experienced during disordered eating patterns.

While the participants in the Mitchell et al. Studies included in this systematic review indicate that CHSP is likely to be a trans-diagnostic behaviour [ 34 , 36 , 38 ]. Therefore, it is the recommendation of the authors of the present systematic review that clinicians consider inquiring about CHSP in all people presenting with an ED or disordered eating.

This review identified a number of limitations in the current research centred on CHSP, all of which appeared to be of modest quality and, one-third of what little literature was found came from case studies. Only one case study involved a person without an ED and few studies undertook an in-depth analysis of the physical, social, or psychological implications of CHSP, with no studies deeply investigating physical or social impacts.

We found no longitudinal studies and men and children with CHSP were severely under-represented in study samples. It is likely that the bias towards female participants was due to the study samples being based in ED clinics and it is known men with EDs are less likely to access treatment services than women [ 40 ].

However, it is also indicative of the relative neglect of men in ED research [ 40 — 42 ]. Longitudinal studies are needed to determine the prolonged effects of CHSP and the impacts on physiological, psychological, and social well-being. Such studies would provide greater insight treatment design for those that engage in CHSP but may not meet full diagnostic ED criteria.

A limitation to this review is that it sourced only English-language studies. One study in Japanese was present in the original literature search and there may have been others if non-English language databases had been searched. This would potentially have increased the number of studies and study participants of non-Caucasian descent.

Another limitation of this systematic review was its inability to source empirical studies on CHSP practices in populations without EDs but with specific dietary requirements, such as individuals with diabetes, athletes, bodybuilders, and bariatric patients. The impact of CHSP on weight loss, as well as possible psychological and medically adverse complications in these groups, is at this time uncertain. Studies should also investigate the precursors and outcomes of CHSP not only in individuals with EDs but also in undiagnosed individuals who engage in CHSP and those who may be at risk of beginning the behaviour.

The small number of poor quality studies published demonstrates that CHSP is an understudied topic. Higher quality studies, including qualitative, quantitative, mixed-methods, and longitudinal studies, are required to add depth to clinical, physiological, psychological, and socioeconomic understandings of CHSP and its treatment.

Such studies would assist in determining if there is a common psychological link between individuals with CHSP behaviour with and without an ED.

Thank you to Melissa Helou, B. Arts, B. Bis, MSW, Griffith University, for assisting in the proofreading of initial draft versions of this review. As this is a review all data presented here is published and in the public domain. PA conceived the research idea, developed the search strategy and methodology, and conducted the initial literature search, quality assessment and draft of manuscript.

NS conducted a secondary literature search, quality assessment and editing of manuscript. ST and PH provided significant input and guidance, assisted in design and methods, drafting and editing the manuscript. All authors have read and approved the final manuscript before submission. ST receives an honorarium from Shire Pharmaceuticals.

Phillip Aouad, Email: ua. Phillipa Hay, Email: ua. Nerissa Soh, Email: ua.

A probability less than 0. Tumor and vascular malformation were found in 4 patients and they were exclusively located at cortex Table 4. Reported causes for the syndrome include infarction of the cortex[ 4 , 5 ], operculum[ 6 ], corona radiata[ 7 ], posterior limb of the internal capsule[ 8 ], thalamus[ 9 ], or brainstem[ 10 , 11 ]. Cortical type-sensory impairment astereognosis, barognosis, or graphesthesia was detected in 6 patients Restricted acral sensory syndrome following minor stroke. Strauss H.

Oral expulsion syndrome

Oral expulsion syndrome

Oral expulsion syndrome

Oral expulsion syndrome

Oral expulsion syndrome. Navigation menu

I have struggled for years with my health and my goal is to help others in any way possible through my experiences! Skip to content. Search for:. I feel like a hypocrite. I really do. I wish I felt that way about my own situation.

I had a physically draining weekend, and now I need rest I want to keep moving forward. I want each second of my life to mean something.

This blog contains my own opinions and does not represent the views or opinions of any other institution.

You must not rely on the information on this website as an alternative to medical advice from your doctor or other professional healthcare provider. No guarantee is given regarding the accuracy of any statements or opinions made on this website. If you have any specific questions about any medical matter, you should consult your doctor or other professional healthcare provider.

Original content displayed on this website is legally obligated to the [Para]Sympathy brand only. In another 6 patients, a variable range of cervical spondylosis was found. In another 4 patients, there was no structural abnormality disclosed. Stroke was identified in 50 patients Small infarction and small hemorrhage were exclusively found at thalamus or pons, except one patient who had cortical infarction presenting with type I COS.

Tumor and vascular malformation were found in 4 patients and they were exclusively located at cortex Table 4. In one Sjogren syndrome patient, her type II COS was ensued by painful polyneuropathy which was reversed by plasmapheresis.

Her nerve conduction velocity study showed sensory axonopathy but magnetic resonance image did not reveal consistent abnormality. Acute myelogenous leukemia with subdural hemorrhage was found in an another type I patient after extensive investigation. In regard to stroke patients, detailed survey for stroke risk factor was performed.

In another one patient with small cortical infarction, atherosclerosis of middle cerebral artery branch was seen. Her cardiac function was normal. Old myocardial ischemia was found in 12 patients and atrial fibrillation in another 2 patients; they also had had hypertension or diabetes mellitus. There was no patient having dissecting disease or other nonatherosclerotic vasculopathy.

There were 9 patients who experienced a deterioration of neurological function ranging from 3 hours to 1 month after onset Table 5. Conservation treatment was performed in another 5 patients. In another 67 patients who did not experience neurological deterioration, there was no specific measure other from cardiovascular risk factor control and stroke secondary prevention in patients with hemorrhage or infarction.

In the Sjogren syndrome patient, plasmapheresis was done. A favorable recovery of COS was ensued in 55 patients within 6 months after onset. Mild to moderate post-stroke central pain occurred in 12 patients and was abolished or attenuated by clonidine, amitriptyline or gabapentin. In those 9 patients with deterioration, mild ataxia was complicated in 2 of them, but moderate to severe functional disability was terminated in another 7 patients Table 5.

Two positive predictors are finally identified, namely crossed COS and cortical involvement. The odd ratio, sensitivity, and specificity were Second, deterioration occurred in 5 out of 12 patients Dizziness and dizziness-minus symptoms were experienced in 49 patients and 7 of them terminated into deterioration, whereas they were not experienced in another 27 patients in whom 2 of them suffered further deterioration.

The odd ratio was 2. Although cortical-type sensory impairment and paroxysm gave a high specificity for predicting cortical involvement, however, the sensitivity was low.

Therefore, the majority of COS cannot be predicted, based simply on clinical history, neurological manifestation and associated symptom. Therefore, it is reasonable and urgent to schedule indispensable procedure, especially neuroimaging study, for COS patients.

Rather, the manner of paresthesia and atypical forms of COS show neuroanatomic correlation. Paroxysmal paresthesia predicted for cortical involvement.

COS also cannot predict for corresponding etiology. Therefore, except for crossed pattern 19 or bilaterality of sensory deficits, 21 COS is not an ideal localizing or etiological marker. Neurological deterioration has subsequently been mentioned in COS patients before.

Crossed COS indicates an involvement of medulla oblongata and is an incomplete variant of Wallenberg's syndrome, 19 in that infarction is due to an occlusion of vertebral artery and usually carries a high risk of deterioration and mortality. Since deterioration can be prevented in some patients, 18 COS should be considered an emergent condition obligatory for aggressive investigation until underlying cause is known.

In the present study, 3 patients should be emphasized because of a diagnostic trap and medicolegal risk in COS. Sjogren syndrome was in one patient. Her cheiro-oral paresthesia peaked rapidly and persisted for one week until pedal painful paresthesia developed simulating cheiro-oral-pedal syndrome. Since there was no consistent finding in head neuroimaging, a symmetric distribution of cheiro-oral-pedal paresthesia favored polyneuritis for her COS.

Her paresthesia was markedly attenuated after plasmapheresis. In another two type I COS patients, one who had had subdural hemorrhage was finally found to have acute myelogenous leukemia. In conclusion, in contrast to previous concept and recent publications, COS is eventually a warning marker predicting for neurological deterioration.

The author has no financial conflicts of interest. National Center for Biotechnology Information , U. Journal List Yonsei Med J v. Yonsei Med J. Published online Dec Wei Hsi Chen. Find articles by Wei Hsi Chen. Author information Article notes Copyright and License information Disclaimer. Corresponding author. Corresponding author: Dr. Tel: ext. This article has been cited by other articles in PMC. Abstract Purpose After a century, cheiro-oral syndrome COS was harangued and emphasized for its localizing value and benign course in recent two decades.

Materials and Methods To analyze the location, underlying etiologies and prognosis in 76 patients presented with COS collected between and Conclusion COS arises from varied sites between medulla and cortex, and is usually caused by small stroke lesion. Keywords: Cheiro-oral syndrome, infarction, hemorrhage, sensory, cortex, pons, thalamus, medulla oblongata, crossed, prognosis.

Classification Basing on the distribution of sensory impairments, four types of COS were categorized. Open in a separate window. Locations of lesions Single lesion was found in 54 patients COS, cheiro-oral syndrome. Corresponding etiologies Stroke was identified in 50 patients Clinical course There were 9 patients who experienced a deterioration of neurological function ranging from 3 hours to 1 month after onset Table 5. Prognosis A favorable recovery of COS was ensued in 55 patients within 6 months after onset.

Footnotes The author has no financial conflicts of interest. References 1. Sitting O. Strauss H. Garcin R, Lapresle J. Kim JS. Restricted acral sensory syndrome following minor stroke.

Further observation with special reference to differential severity of symptoms among individual digits. Cheiro-oral syndrome: identification of the lesion sites and a proposal for its clinical classification. Ten Holter J, Tijssen C. Cheiro-oral syndrome: does it have a specific localizing value? Eur Neurol. Transient cheiro-oral syndrome due to a ruptured intracranial dermoid cyst.

Chew & Spit | [Para]Sympathy

Nausea encapsulates your body, but hunger remains. Physically early satiety is an everyday occurrence, but your mental appetite is insatiable. Vomiting marathons rob you of many bowls of soup, but your cravings stand strong. When I had a large tube protruding from my abdomen, it fed my body but not my appetite.

I have such severe gastroparesis that even the supposedly safe process of chewing and spitting becomes hazardous. Just say no, kids. We reward ourselves with treats when we reach goals. We show our love for others with food. We use food as comfort to pick up our spirits in time of despair.

Heck, we surround ourselves with food in pretty much every social situation: parties, movies, holidays, weddings. The girl who can barely keep down her pills after a sip of water?

I watch. So guess what? Michael always gets me a carry-out to take home to chew and spit. Michael realizes how difficult it is for me to live on a day to day basis. Having to be teased with meat dangling in front of my face literally on top of it all is just inhumane.

The chew and spits at the end of an exhausting evening of watching people eat, drink, socialize, remain conscious and make blissful memories aka, all things I cannot do without repercussions, hospitalization or at all are my reward. You do well, you get a treat. I endure the agonizing severity of my illness for a long while, I get to pretend eat. Happy happy, joy joy. Trust me, I have felt like the scum of the earth for years wasting food.

When I sit in our dining room and spit an evening meal we share, I should be engulfing it. So, now what? I want to use my body as God intended with as little tubes and lines as possible. I have to give partial credit to chewing and spitting. As I chew and spit, some of the liquids do pass through into my stomach.

This can be a blessing and a curse. The blessing comes with the calories. When I chew and spit in small increments, the little amount of calories I get adds to my daily intake. This, plus my normal liquid food, keeps me balanced. And sometimes I chew and spit a little too much out of hunger. I have to be careful what types of food I chew.

Anything too liquid-y may end up in the toilet rather than in the garbage. Salad with dressing, pastas with butter or creamy sauces, cereal, etc. Some say that I have excellent willpower for being able to put food in my mouth and spit it out.

The hunger gets to me because I am spitting this food out. Sure, I get to taste it. These days are when chewing and spitting is a fine line between therapeutic and detrimental to my health. I pondered about this emotion attached to an action I do so frequently. I have trouble even admitting it to my doctors or acquaintances. I just discovered why…. I will go for a longer slurp before asking him to hide it from me to avoid any last binge gulps. Where do I take a step back? Dolly Parton talked about it in her book, referencing that she used to chew and spit to lose weight.

I was blown away to find out that this is common practice amongst girls who want to remain thin but enjoy food. Thinking about it now, I can understand how this works. The idea that people, who are capable of eating, resorting to a method of wasting food yes, in this case it is wasting to maintain or lose weight is still unsettling.

The ins, outs and around-the-bends of the art of Chewing and Spitting. I do it loud, proud and often. I do it to stay sane. The benefits totally outweigh the risks. With coping mechanisms, leave no stone unturned. I agree with Dolly Parton, whether there is a disease or not.

They have found another method, that works for them, of staying at a decent weight. Like Like. You are commenting using your WordPress. You are commenting using your Google account. You are commenting using your Twitter account. You are commenting using your Facebook account. Notify me of new comments via email. Notify me of new posts via email. I have struggled for years with my health and my goal is to help others in any way possible through my experiences!

Skip to content. I just discovered why… Oral Expulsion Syndrome OES I was told once that chewing and spitting is a characteristic of anorexics or bulimics. Share this: Twitter Facebook. Like this: Like Loading I have been struggling for years with my health and my goal is to help others in any way possible through my experiences.

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I wish I felt that way about my own situation. I had a physically draining weekend, and now I need rest I want to keep moving forward.

I want each second of my life to mean something. This blog contains my own opinions and does not represent the views or opinions of any other institution. You must not rely on the information on this website as an alternative to medical advice from your doctor or other professional healthcare provider. No guarantee is given regarding the accuracy of any statements or opinions made on this website. If you have any specific questions about any medical matter, you should consult your doctor or other professional healthcare provider.

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Oral expulsion syndrome

Oral expulsion syndrome

Oral expulsion syndrome