Baclofen cuts gastroesophageal reflux

By David Douglas

NEW YORK (Reuters Health) – The GABA receptor type b agonist baclofen produces a significant reduction in episodes of gastroesophageal reflux in patients with gastroesophageal reflux disease, Australia and Swedish researchers report in the January issue of Gut.

In fact, senior author Dr. Richard H. Holloway, of Royal Adelaide Hospital, told Reuters Health that "this points the way to a new therapeutic approach for the treatment of reflux that does not involve inhibition of acid production by the stomach."

In earlier work in normal subjects, the researchers established that baclofen was a "potent inhibitor" of transient lower esophageal sphincter relaxation, the major cause of reflux. To determine if this might also be the case in those with gastroesophageal reflux disease, the team studied 20 such patients.

In this crossover study, on two occasions at least 1 week apart, the subjects were randomized to receive 40 mg of oral baclofen or placebo 90 minutes before eating. The 750 kilocalorie meal consisted of minced meat, mashed vegetables, milk, and ice cream.

Baclofen treatment reduced the number of esophageal sphincter relaxations by a significant 40% (from 15 to 9) in the 3 hours after the meal. Also significant was the 43% reduction in the number of reflux episodes (from seven to four) over the same period. There was no effect on esophageal acid exposure.

In light of these findings, Dr. Holloway continued, "such an approach may be useful not only as primary treatment of reflux disease but also as an adjunct to acid inhibition where this has not given adequate control."

In an accompanying commentary, Drs. J. Tack and D. Sifrim, of the University of Leuven, Belgium, agree, pointing out that "both strategies are not exclusive and may become complementary in the near future."

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