Baclofen Improves Symptoms and Reduces Postprandial Flow Events in Patients With Rumination and Supragastric Belching
Baclofen Improves Symptoms and Reduces Postprandial Flow Events in Patients With Rumination and Supragastric Belching
复制标题
DOI：
10.1016/j.cgh.2011.10.042
复制
发表时间：
2012-04-01
影响因子：
12.6
通讯作者：
Tack, Jan F.
中科院分区：
文献类型：
--
作者：
Blondeau, Kathleen;Boecxstaens, Veerle;Tack, Jan F.
背景与目的：在临床疑似反刍的患者中，食管阻抗测压可区分反刍发作（胃内压力增加的不自主紧张）与吞气症/胃上打嗝。治疗选择有限，主要集中在行为疗法上。巴氯芬是一种γ-氨基丁酸B受体激动剂，可增加下食管括约肌压力并降低吞咽率。我们研究了它对这些患者的影响。方法：在巴氯芬（10 mg，每日3次）治疗前和治疗期间，对12例临床疑似反刍或胃上打嗝的患者（8例女性，平均年龄45岁，范围18-89岁）进行高分辨率测压-阻抗记录。记录30分钟后，患者接受1000千卡固体餐;然后记录持续1小时。要求患者用事件标记登记症状。在治疗前和治疗期间比较登记的症状数量以及流量事件的数量和类型。研究结果：基线时记录了平均20个症状标志物（范围，14-34）（打嗝10个[范围，4-25]，反流9个[范围，0-11]）。在巴氯芬治疗期间，这显著降低至6（范围，2-22）（3 [范围，1-15]为打嗝，1 [范围，0-13]为反流）（P = .01）。在巴氯芬治疗期间，血流事件的数量（基线时473例[42例反流，192例反刍，188例胃上打嗝和42例吞气症]）显著减少至282例（32例反流，99例反刍，123例胃上打嗝和13例吞气症）（P = .02）。血流事件的减少与下食管括约肌压力的增加（r = -0.62; P = 0.03）和吞咽频率的减少（r = 0.64; P = 0.02）相关。结论：巴氯芬是一种有效的治疗反刍或胃上嗳气/吞气症的患者。
BACKGROUND & AIMS: 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 gamma-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.