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Baclofen Reduces Symptoms of Duodenogastroesophageal Reflux.

ATLANTA -- Baclofen inhibits transient lower esophageal sphincter relaxations associated with duodenogastroesophageal reflux, Dr. Geert Koek said at the annual Digestive Disease Week.

According to Dr. Geert Koek of Catholic University, Leuven, Belgium, duodenogastroesophageal reflux disease is differentiated from gastroesophageal reflux disease by significant amounts of refluxed bile from the duodenum. Patients can have persistent symptoms and lesions despite high doses of proton pump inhibitor (PPI) therapy

Dr. Koek and his colleagues decided to treat patients with PPI therapy and baclofen, a [gamma]-aminobutyric acid type B receptor agonist / antispasmodic that has been shown to inhibit transient lower esophageal sphincter relaxation. Patients taking high doses of PPI therapy were eligible for the study if they had normal results on pH monitoring and pathologic findings on monitoring with a fiberoptic probe that measures exposure to bilirubin. Eligible patients also had to have been taking high doses of PPI therapy for at least 3 months and had persistent heartburn or regurgitation.

Fifteen patients (11 women) with a mean age of 43 were included in the study All of the patients had endoscopy and a reflux symptom score taken at baseline. Seven of the 15 had erosive esophagitis. Under high-dose PPI alone, all of the patients had normal acid exposure and high levels of bile exposure.

Baclofen treatment was initiated at 5 mg t.i.d. The dosage was increased by 5 mg per dose increments once every fourth day until a maintenance dosage of 20 mg t.i.d. was reached. Reflux symptom score, pH, and bilirubin levels were repeated 4 days after subjects reached the 20 mg t.i.d. maintenance dosage.

After the addition of baclofen, acid exposure was similar to that seen with PPI alone, but the bile exposure had significantly decreased. The number of reflux episodes and the number of long-lasting reflux episodes were significantly decreased. Severity score for nine reflux symptoms also decreased by nearly half. Four patients reported side effects of nausea or drowsiness.
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Author:MULCAHY, NICHOLAS
Publication:Internal Medicine News
Geographic Code:4EUBL
Date:Sep 1, 2001
Words:327
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