Original article—alimentary tract
Baclofen Improves Symptoms and Reduces Postprandial Flow Events in Patients With Rumination and Supragastric Belching

https://doi.org/10.1016/j.cgh.2011.10.042Get rights and content

Background & Aims

In patients with clinically suspected rumination, esophageal impedance manometry differentiates episodes of rumination (involuntary straining with intragastric pressure increases) from aerophagia/supragastric belching. Treatment options are limited and focused on behavioral therapy. Baclofen, an agonist of the γ-aminobutyric acid B receptor, increases lower esophageal sphincter pressure and decreases swallowing rate. We investigated its effects in these patients.

Methods

High-resolution manometry-impedance recordings were taken from 12 patients (8 women; mean age, 45 years; range, 18–89 years) with clinically suspected rumination or supragastric belching before and during treatment with baclofen (10 mg, 3 times daily). After 30 minutes of recordings, patients received a 1000-kcal solid meal; recordings were then continued for 1 hour. Patients were asked to register symptoms with an event marker. The number of symptoms registered and number and type of flow events were compared before and during treatment.

Results

An average of 20 symptom markers (range, 14–34) were recorded at baseline (10 [range, 4–25] for belching and 9 [range, 0–11] for regurgitation). This was significantly reduced to 6 (range, 2–22) (3 [range, 1–15] for belching and 1 [range, 0–13] for regurgitation) during baclofen treatment (P = .01). The number of flow events (473 at baseline [42 reflux, 192 rumination, 188 supragastric belching, and 42 aerophagia]) was significantly reduced to 282 (32 reflux, 99 rumination, 123 supragastric belching, and 13 aerophagia) during baclofen therapy (P = .02). The reduction in flow events correlated with the increase in lower esophageal sphincter pressure (r = −0.62; P = .03) and reduction in swallowing frequency (r = 0.64; P = .02).

Conclusions

Baclofen is an effective treatment for patients with rumination or supragastric belching/aerophagia.

Section snippets

Patients

We studied 16 patients (10 women; mean age, 43 years; range, 18–89 years) with a clinical suspicion of rumination. All patients had undergone upper gastrointestinal endoscopy and empiric proton pump inhibitor (PPI) and prokinetic therapy without clear explanation of the symptoms and without beneficial symptomatic effect.

Study Protocol

All patients underwent stationary high-resolution manometry (HRM)-impedance recordings after an overnight fast. The manometry-impedance assembly (Medical Measurement Systems,

Results

Twelve patients (8 women; mean age, 45 years; range, 18–89 years) were included in the final analysis. Four patients were excluded from the study because they refused the second HRM-impedance recording while on baclofen. Ten patients presented with predominant symptoms of regurgitation, whereas 2 patients presented with predominant symptoms of belching.

Four of the 12 patients included in the final analysis reported side effects of sleepiness and difficulty to concentrate during baclofen

Discussion

The GABAB agonist baclofen has been shown to increase the basal LES pressure and to reduce the number of TLESRs, resulting in reduction of acid and nonacid reflux in GERD patients.10, 11, 12, 13 The increase in LES function might be potentially beneficial in patients with rumination syndrome because it might increase the threshold to induce upward movement of liquid gastric contents or gas into the esophagus during straining. In addition to an improved LES function, baclofen decreases the

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    Conflicts of interest The authors disclose no conflicts.

    Funding Drs Blondeau and Farré receive funding from the FWO Flanders. This study was funded by a Methusalem grant from Leuven University to Prof Tack.

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