Effect of baclofen on emesis and 24-hour esophageal pH in neurologically impaired children with gastroesophageal reflux disease.
OBJECTIVE
Gastroesophageal reflux disease (GERD) is difficult to control with medical therapy in neurologically impaired children. The gamma-aminobutyric acid type B receptor agonist baclofen was recently reported to reduce reflux in adult patients with GERD by reducing the incidence of transient lower esophageal sphincter relaxations. The current study was undertaken to investigate the effects of baclofen on GERD in neurologically impaired children.


METHODS
Eight neurologically impaired children with GERD between 2 months and 16 years were studied. Baclofen (0.7 mg/kg/day) was administered orally or via nasogastric tube in three divided doses 30 minutes before meals for 7 days. The frequency of emesis on and off baclofen were recorded as a measure of clinical impact. Twenty-four-hour esophageal pH monitoring was conducted before and on the seventh day of the administration of baclofen.


RESULTS
The frequency of emesis was significantly decreased (P = 0.03). The total number of acid refluxes was significantly decreased both during the entire 24-hour period (P = 0.01) and during the postprandial period (P = 0.049). The number of acid refluxes longer than 5 minutes was significantly decreased during the 24-hour period (P = 0.02). The percentage total time of esophageal pH <4.0 and esophageal acid clearance time were not significantly different during the 24-hour period or during the postprandial period. No adverse effects were observed, except for a slight reduction in muscle tone in one subject.


CONCLUSIONS
In this 1-week trial, repetitive administration of baclofen reduced the frequency of emesis and the total number of acid refluxes in neurologically impaired children with GERD.
Kawai
Masanobu
M
Department of Pediatric Gastroenterology and Nutrition, Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, Japan.
Kawahara
Hisayoshi
H
Hirayama
Satoru
S
Yoshimura
Norikazu
N
Ida
Shinobu
S
D000284:Administration, Oral; D000293:Adolescent; D001418:Baclofen / Q000627:therapeutic use*; D002547:Cerebral Palsy / Q000150:complications; D002648:Child; D002675:Child, Preschool; D003635:De Lange Syndrome / Q000150:complications; D004947:Esophagus / Q000737:chemistry; D005260:Female; D018755:GABA Agonists / Q000627:therapeutic use*; D005745:Gastric Acidity Determination; D005764:Gastroesophageal Reflux / Q000150:complications / Q000188:drug therapy* / Q000209:etiology; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007223:Infant; D007441:Intubation, Gastrointestinal; D008297:Male; D018670:Monitoring, Ambulatory; D008991:Monitoring, Physiologic; D019518:Postprandial Period; D013036:Spasms, Infantile / Q000150:complications; D016896:Treatment Outcome; D014839:Vomiting / Q000188:drug therapy* / Q000453:epidemiology / Q000209:etiology
D018755:GABA Agonists; D001418:Baclofen