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- Title
Effect of baclofen on gastric acid pocket in subjects with gastroesophageal reflux disease symptoms.
- Authors
Scarpellini, E.; Boecxstaens, V.; Broers, C.; Vos, R.; Pauwels, A.; Tack, J
- Abstract
Postprandial gastroesophageal reflux ( PGER) in the distal esophagus ( DE) is associated with a gastric juice 'acid pocket' ( AP). Baclofen reduces AP extension into the DE in healthy volunteers, in part through increased lower esophageal sphincter ( LES) pressure. We aimed to verify whether baclofen also affects postprandial AP location and extent in gastroesophageal reflux disease ( GERD) patients. Thirteen treatment-naive heartburn-prevalent GERD patients underwent two AP studies, after pretreatment with baclofen 40 mg or placebo 30 minutes preprandially. We performed pH-probe stepwise pull-throughs ( PT) (1 cm/min, LES −10 to +5 cm) before and every 30 minutes from 30 minutes before up to 150 minutes after a test meal. After the meal, both after placebo and baclofen, gastric pH significantly dropped at 30, 60, 90 minutes postprandially ( P: nadir pHs of 3.9 ± 0.6, 2.3 ± 0.6, 2.1 ± 0.4; B: nadir pHs of 2.5 ± 0.4, 2.8 ± 0.4, 2.5 ± 0.3; all P < 0.05). After placebo, LES pressure decreased at 60, 90 and 120 minutes postprandially (32.7 ± 6.1 vs. 24.5 ± 3.1, 27.3 ± 5.9, 27.3 ± 6.0 mmHg; analysis of variance [ ANOVA], P = 0.037), but this was prevented by baclofen (25.4 ± 3.4 vs. 29.4 ± 2, 32.2 ± 1.4, 35.5 ± 1.7 mmHg, ANOVA, P = not significant (NS)). Baclofen did not significantly decrease the postprandial AP extent above the LES but prevented the postprandial increase in transient lower esophageal sphincter relaxations ( TLESRs) (preprandial vs. postprandial, placebo: 1.1 ± 0.3 vs. 3.7 ± 0.7, P < 0.05; baclofen: 1.4 ± 0.4 vs. 2 ± 0.5, P = NS). In GERD patients, baclofen significantly increases postprandial LES pressure, prevents the increase TLESRs but, unlike in healthy volunteers, does not affect AP extension into the DE.
- Subjects
ESOPHAGOGASTRIC junction; BACLOFEN; TREATMENT of esophageal cancer; GASTRIC acid; GASTROESOPHAGEAL reflux; GABA receptors; SYMPTOMS; THERAPEUTICS
- Publication
Diseases of the Esophagus, 2016, Vol 29, Issue 8, p1054
- ISSN
1120-8694
- Publication type
Article
- DOI
10.1111/dote.12443