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Baclofen for the treatment of pediatric GERD
Narendra B Vadlamudi1, Meredith C Hitch, Reed A Dimmitt
1Division of Pediatric Gastroenterology and Nutrition, Children's of Alabama, Birmingham, AL.
Insights
Baclofen shows promise in reducing gastroesophageal reflux (GER) symptoms in children when used alongside proton pump inhibitors. Many young patients experienced symptom relief, with a sustained response observed in most over 12 months.
Area of Science:
- Pediatric Gastroenterology
- Pharmacology
Background:
- Gastroesophageal reflux (GER) is common in children.
- Baclofen, a GABA receptor agonist, reduces transient lower esophageal relaxations, a key GER mechanism.
- Limited data exist on baclofen's efficacy in pediatric GER.
Purpose of the Study:
- To evaluate the effectiveness of baclofen as a treatment for refractory GER in pediatric patients.
- To assess both short-term and long-term clinical responses to baclofen therapy.
Main Methods:
- Retrospective chart review of 53 pediatric patients (1-18 years) with persistent GER symptoms treated with baclofen.
- Patients were on proton pump inhibitors (PPIs) prior to baclofen initiation.
- Clinical responses were assessed at the first visit and after 12 months of treatment.
Main Results:
- 66% of patients showed significant symptom reduction at short-term follow-up.
- Of those continuing treatment, 81% maintained a sustained response at 12 months.
- 19% lost response, and 3 patients discontinued due to adverse events.
Conclusions:
- Baclofen can be an effective supplemental therapy for refractory GER in children, in conjunction with PPIs.
- Further prospective trials are necessary to confirm these findings and evaluate safety.
- No specific patient characteristics predicted response or lack thereof.
Background And Aim:
Baclofen, a γ-aminobutyric acid receptor agonist, has been shown to reduce the episodes of gastroesophageal reflux (GER) by reducing the incidence of transient lower esophageal sphincter relaxations. Although baclofen has been shown to reduce reflux symptoms in adults, data in pediatric patients are limited. The aim of the study was to evaluate the efficacy of baclofen in children with refractory GER.
Methods:
Medical charts of patients 1 to 18 years of age treated with baclofen for persistent GER symptoms were reviewed retrospectively. Short-term (at first clinic visit) and long-term (12 months) clinical responses were assessed.
Results:
A total of 53 patients were included in the final analysis. The mean duration of illness was 1.5 years and the mean age was 6.1 years. All of the patients were taking either once- (53%) or twice-daily (47%) doses of proton pump inhibitors (PPIs) at the time of initiation of baclofen. Thirty-five (66%) patients experienced a significant reduction in clinical symptoms at their first follow-up visit. In the remaining 18 patients, however, baclofen was stopped because of either no response (n = 15) or adverse events (n = 3). A total of 27 patients continued treatment and were assessed for long-term response. Of those, 22 (81%) had a sustained response to baclofen at 12 months, whereas 5 (19%) lost response. We recognized no clinical characteristic differences between those with and without a response to baclofen at either time point.
Conclusions:
Baclofen can be used as supplemental therapy to proton pump inhibitors in children with refractory GER; however, prospective trials are needed to further validate our results and assess safety.
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