OESOPHAGUS

Effect of acute and chronic administration of the GABA_B agonist baclofen on 24 hour pH metry and symptoms in control subjects and in patients with gastro-oesophageal reflux disease

A F Ciccaglione, L Marzio

University G d’ Annunzio, Chieti-Pescara, Italy

Correspondence to:
Correspondence to:
Professor L Marzio, G d’Annunzio University, Medicina I Ospedale Civile, Via Fonte Romana 8, 65124 Pescara, Italy;
marzio{at}unich.it

Background and aims: The -aminobutyric acid (GABA_B) agonist baclofen has been shown to reduce reflux episodes during the first three postprandial hours in patients with gastro-oesophageal reflux disease (GORD) and in normal controls. The aim of the study was to assess the effect of acute (one day) and chronic (four weeks) administration of baclofen on 24 hour pH metry and symptoms in GORD patients and normal controls.

Patients and methods: Acute study: 28 patients with GORD with none or mild oesophagitis at endoscopy and 15 controls underwent oesophageal and gastric 48 hour pH metry in which baclofen or placebo was given for 24 hours in a double blinded manner. Chronic study: 16 GORD patients received baclofen (10 mg four times daily) or placebo for four weeks. Twenty four hour oesophageal pH metry and reflux symptom scores were evaluated before and at the end of treatment.

Results: Acute study: the number of reflux episodes and per cent time with pH <4 was significantly lower after baclofen in GORD patients and controls (p<0.003; p<0.0007). Gastric pH increased significantly in GORD patients and controls (p<0.001; p<0.05). Chronic study: four weeks after initial administration of baclofen, the number of reflux episodes and percentage of time with pH <4 significantly decreased in all GORD patients (p<0.003; p<0.02). Symptom scores significantly improved after treatment with baclofen (p<0.0007).

Conclusions: The GABA_B agonist baclofen reduces 24 hour gastro-oesophageal reflux and increases gastric pH in GORD patients and controls. When given for one month to GORD patients, baclofen reduces oesophageal acid refluxes and significantly improves symptoms. Baclofen may be useful in the therapy of GORD.

Keywords: baclofen; GABA; gastro-oesophageal reflux

Abbreviations: GORD, gastro-oesophageal reflux disease; GABA, -aminobutyric acid; LOS, lower oesophageal sphincter; TLOSR, transient lower oesophageal sphincter relaxations

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