Pressure and length of the lower esophageal sphincter as predictive indicators of therapeutic efficacy of baclofen for refractory gastroesophageal reflux-induced chronic cough

Zhu, Yiqing; Xu, Xianghuai; Zhang, Mengru; Si, Fengli; Sun, Huihui; Yu, Li; Qiu, Zhongmin

doi:10.1016/j.rmed.2021.106439

Cited by 8 publications

(18 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Is baclofen a proper choice in patients with GERC? 64% of individuals in this category were the patients of Zhu et al's (42) study. The issue that is remarkable about their study is that they prescribed baclofen as monotherapy without PPI.…”

Section: Efficacymentioning

confidence: 92%

“…Some clinicians administer low dose baclofen and increment the dosage as a precaution against baclofen adverse effects. This approach was utilized in six of our trials (15,16,19,20,25,42). However, results are inconclusive due to lack of studies comparing high-dose baclofen at the beginning of treatment with the incremental dosing mentioned above in adverse effects.…”

Section: Scarpellini Et Al (33)mentioning

confidence: 99%

“…Baclofen may benefit a diverse population including: adults, infants with refractory regurgitation, neurologically impaired children with GERD, patients with GERC, and patients with hiatal hernia may benefit from baclofen. Of the twenty-six included, only Bajbouj et al (19) and Zhu et al (42) advised against using baclofen for the treatment of reflux disease.…”

Section: Efficacymentioning

confidence: 99%

“…However, in all other studies, baclofen was significantly more effective than placebo in treating GERD patients who did not respond to PPI; we cannot independently explain 42) recommended against using baclofen because of its unsatisfactory efficacy and side effects. They discovered that LES pressure with a cut-off point of 11 mmHg (with a sensitivity of 83.1% and a specificity of 79.1%) and LES length with a cut-off point of 2.35 cm (with a sensitivity of 81.6% and a specificity of 72.1%) are the independent predictors of baclofen efficacy in reflux disease (42). Although the population of the study was limited to patients with refractory GERC, considering the mechanism of baclofen on GERD, it may be possible to use these cut-off points for all patients with refractory GERD; but more studies are needed to determine these cut-offs.…”

Section: Efficacymentioning

confidence: 99%

See 3 more Smart Citations

Baclofen as a therapeutic option for gastroesophageal reflux disease: A systematic review of clinical trials

Arabpour

Khoshdel²,

Akhgarzad³

et al. 2023

Front. Med.

View full text Add to dashboard Cite

BackgroundThe main components of gastroesophageal reflux disease (GERD) management include a combination of medications and lifestyle modifications; Nevertheless, based on the severity of symptoms and their response to medications, other treatments could be considered. Baclofen has been demonstrated in studies to relieve GERD symptoms. The current study aimed to precisely address the effects of baclofen on the treatment of GERD and its characteristics.MethodsA systematic search was carried out in Pubmed/Medline, Cochrane CENTRAL, Scopus, Google Scholar, Web of Science, and clinicaltrials.gov up to December 10, 2021. The search terms included baclofen, GABA agonists, GERD, and reflux.ResultsWe selected 26 papers that matched the inclusion criteria after examining 727 records. Studies were classified into four categories based on the study population and reported outcomes: (1) adults, (2) children, (3) patients with gastroesophageal reflux-induced chronic cough, (4) hiatal hernia patients. The results revealed that baclofen can significantly improve reflux symptoms and pH-monitoring and manometry findings to different degrees in all four mentioned categories; although its effect on pH-monitoring parameters seems less significant than the other parameters. Mild neurological and mental status deterioration were the most reported side effects. However, side effects occurred in a portion of less than 5% of short-term users and nearly 20% of long-term users.ConclusionIn PPI-resistant patients, a trial of adding baclofen to the PPI may be helpful. Baclofen therapies may be more beneficial for symptomatic GERD patients who also report concurrent conditions including alcohol use disorder, non-acid reflux, or obesity.Systematic review registrationhttps://clinicaltrials.gov/.

show abstract

Section: Efficacymentioning

confidence: 92%

Section: Scarpellini Et Al (33)mentioning

confidence: 99%

Section: Efficacymentioning

confidence: 99%

Section: Efficacymentioning

confidence: 99%

See 2 more Smart Citations

Baclofen as a therapeutic option for gastroesophageal reflux disease: A systematic review of clinical trials

Arabpour

Khoshdel²,

Akhgarzad³

et al. 2023

Front. Med.

View full text Add to dashboard Cite

show abstract

“…As a result, the therapeutic relevance and significance of screening the most suited individuals with refractory GERC for baclofen treatment is significant. A recent study suggests that LESP (lower esophageal sphincter pressure) and LESL (lower esophageal sphincter pressure) can be used to screen refractory GERC patients for baclofen treatment ( Zhu et al, 2021b ).…”

Section: Treatmentmentioning

confidence: 99%

GERD-related chronic cough: Possible mechanism, diagnosis and treatment

Chen

2022

Front. Physiol.

View full text Add to dashboard Cite

GERD, or gastroesophageal reflux disease, is a prevalent medical condition that affects millions of individuals throughout the world. Chronic cough is often caused by GERD, and chronic cough caused by GER is defined as GERD-related chronic cough (GERC). It is still unclear what the underlying molecular mechanism behind GERC is. Reflux theory, reflex theory, airway allergies, and the novel mechanism of esophageal motility disorders are all assumed to be linked to GERC. Multichannel intraluminal impedance combined with pH monitoring remains the gold standard for the diagnosis of GERC, but is not well tolerated by patients due to its invasive nature. Recent discoveries of new impedance markers and new techniques (mucosal impedance testing, salivary pepsin, real-time MRI and narrow band imaging) show promises in the diagnosis of GERD, but the role in GERC needs further investigation. Advances in pharmacological treatment include potassium-competitive acid blockers and neuromodulators (such as Baclofen and Gabapentin), prokinetics and herbal medicines, as well as non-pharmacological treatments (such as lifestyle changes and respiratory exercises). More options have been provided for the treatment of GERC other than acid suppression therapy and anti-reflux surgery. In this review, we attempt to review recent advances in GERC mechanism, diagnosis, and subsequent treatment options, so as to provide guidance for management of GERC.

show abstract

Efficacy of Baclofen as Add-on Therapy for Refractory Gastroesophageal Reflux Disease

Dong,

Luo,

Liu

et al. 2024

Journal of Clinical Gastroenterology

View full text Add to dashboard Cite

Objectives: As a GABAB receptor agonist, baclofen has demonstrated efficacy in alleviating symptoms of refractory gastroesophageal reflux disease (r-GERD). This meta-analysis aims to evaluate the safety and effectiveness of baclofen as an add-on therapy for this condition. Method: We conducted a comprehensive search of the PubMed, Embase, and Web of Science databases for studies published up until October 2023. Subsequently, we performed a meta-analysis encompassing all eligible trials. Results: From 719 records, 10 studies were included, most of these studies were moderate risk. The findings demonstrated that the addition of baclofen as a supplementary treatment effectively improves symptoms (GERD Q score) in r-GERD (standardized mean difference=−0.78, 95% CI: −1.06 to −0.51, I 2=0%). The addition of this treatment also resulted in a decrease in the frequency of nonacidic reflux episodes (standardized mean difference=−0.93, 95% CI: −1.49 to −0.37, I 2=63%) and an improvement in DeMeester scores (standardized mean difference=−0.82, 95% CI: −1.61 to −0.04, I 2=81%) among patients with r-GERD when compared with the use of proton pump inhibitor (PPI) drugs alone. However, no significant disparity was observed in terms of reducing acid reflux episodes (standardized mean difference=−0.12, 95% CI: −0.49 to 0.19, I 2=0%) and proximal reflux (standardized mean difference=−0.47, 95% CI: −1.08 to 0.14, I 2=60%). Conclusion: Baclofen as an add-on treatment can effectively improve the symptoms of patients with r-GERD and reduce the incidence of nonacidic reflux and improve DeMeester score. However, long-term use of baclofen leads to an increased incidence of side effects and is not effective in reducing the occurrence of acid reflux.

show abstract

Pressure and length of the lower esophageal sphincter as predictive indicators of therapeutic efficacy of baclofen for refractory gastroesophageal reflux-induced chronic cough

Cited by 8 publications

References 25 publications

Baclofen as a therapeutic option for gastroesophageal reflux disease: A systematic review of clinical trials

Baclofen as a therapeutic option for gastroesophageal reflux disease: A systematic review of clinical trials

GERD-related chronic cough: Possible mechanism, diagnosis and treatment

Efficacy of Baclofen as Add-on Therapy for Refractory Gastroesophageal Reflux Disease

Contact Info

Product

Resources

About