title: Baclofen improves symptoms and reduces postprandial flow events in patients with rumination and supragastric belching.
abstract: OBJECTIVE
  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.
authors.affiliation: Translational Research Center for Gastrointestinal Disorders (TARGID), University of Leuven, Leuven, Belgium.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Blondeau
authors.forename: Veerle
authors.initials: V
authors.lastname: Boecxstaens
authors.forename: Nathalie
authors.initials: N
authors.lastname: Rommel
authors.forename: Richard
authors.initials: R
authors.lastname: Farré
authors.forename: Stephanie
authors.initials: S
authors.lastname: Depeyper
authors.forename: Lieselot
authors.initials: L
authors.lastname: Holvoet
authors.forename: Guy
authors.initials: G
authors.lastname: Boeckxstaens
authors.forename: Jan F
authors.initials: JF
authors.lastname: Tack
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001418:Baclofen / Q000008:administration & dosage*; D004884:Eructation / Q000175:diagnosis / Q000188:drug therapy*; D019959:Feeding and Eating Disorders of Childhood / Q000175:diagnosis / Q000188:drug therapy*; D005260:Female; D058786:GABA-B Receptor Agonists / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D008365:Manometry / Q000379:methods; D008875:Middle Aged; D019518:Postprandial Period / Q000187:drug effects*; D055815:Young Adult
chemical_list: D058786:GABA-B Receptor Agonists; D001418:Baclofen