title: Therapeutic efficacy of baclofen in refractory gastroesophageal reflux-induced chronic cough.
abstract: OBJECTIVE
  To evaluate the efficacy and safety of baclofen for treatment of refractory gastroesophageal reflux-induced chronic cough (GERC) unresponsive to standard anti-reflux therapy.
  
  
  METHODS
  Sixteen patients with refractory GERC were given an 8-wk course of baclofen 20 mg three times a day as an add-on therapy to omeprazole. Changes in the cough symptom score, cough threshold to capsaicin, reflux symptom score and possible adverse effects were determined after treatment. The variables of multi-channel intraluminal impedance combined with pH monitoring were compared between responders and non-responders to baclofen.
  
  
  RESULTS
  Twelve of 16 patients completed treatment. Cough disappeared or improved in 56.3% (9/16) of patients, including 6 patients with acid reflux-induced cough (66.7%) and 3 patients with non-acid reflux-induced cough (33.3%). With baclofen treatment, the cough symptom score began to decrease at week 2, was clearly decreased at week 6 and reached a minimum at week 8. At the end of therapy, the lowest concentration of capsaicin required for induction of ≥ 2 and ≥ 5 coughs increased from 0.98 (1.46) to 1.95 (6.82) μmol/L (Z = -2.281, P = 0.024) and from 1.95 (7.31) to 7.8 (13.65) μmol/L (Z = -2.433, P = 0.014), respectively, and the reflux symptom score decreased from 8.0 ± 1.6 to 6.8 ± 0.8 (t = 2.454, P = 0.023). The number of acid reflux episodes was significantly lower in responders than in non-responders. The main adverse effects were somnolence, dizziness and fatigue.
  
  
  CONCLUSIONS
  Baclofen is a useful, but suboptimal treatment option for refractory GERC.
authors.affiliation: Department of Respiratory Medicine, Tongji Hospital, Tongji University School of Medicine, Shanghai 200065, China.
authors.forename: Xiang-Huai
authors.initials: XH
authors.lastname: Xu
authors.forename: Zhong-Min
authors.initials: ZM
authors.lastname: Yang
authors.forename: Qiang
authors.initials: Q
authors.lastname: Chen
authors.forename: Li
authors.initials: L
authors.lastname: Yu
authors.forename: Si-Wei
authors.initials: SW
authors.lastname: Liang
authors.forename: Han-Jing
authors.initials: HJ
authors.lastname: Lv
authors.forename: Zhong-Min
authors.initials: ZM
authors.lastname: Qiu
mesh_terms: D000328:Adult; D001418:Baclofen / Q000627:therapeutic use*; D002211:Capsaicin / Q000627:therapeutic use; D015331:Cohort Studies; D003371:Cough / Q000175:diagnosis*; D004294:Domperidone / Q000627:therapeutic use; D050782:Esophageal pH Monitoring; D005260:Female; D005764:Gastroesophageal Reflux / Q000188:drug therapy*; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008297:Male; D008875:Middle Aged; D009125:Muscle Relaxants, Central / Q000627:therapeutic use*; D009853:Omeprazole / Q000627:therapeutic use; D054328:Proton Pump Inhibitors / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D009125:Muscle Relaxants, Central; D054328:Proton Pump Inhibitors; D004294:Domperidone; D001418:Baclofen; D009853:Omeprazole; D002211:Capsaicin
keywords: Baclofen; Cough; Esophageal pH monitoring; Gastroesophageal reflux; Proton pump inhibitors