Effect of Baclofen and Nexium on Acid and Nonacid Gastroesophageal Reflux Measured by Multichannel Intraluminal Impedance and pH (MII/pH)

Abstract

Purpose: Persistent GERD symptoms while on adequate acid suppression with PPI may be due to nonacid reflux. Using Multichannel Intraluminal Impedance and pH (MII/pH) we have previously shown a decrease in both acid and nonacid reflux after treatment with baclofen, a GABA B agonist that inhibits transient lower esophageal sphincter relaxations. The purpose of our study was to compare the frequencies of acid and nonacid reflux after therapy with baclofen and esomeprazole. Methods: GERD patients diagnosed by endoscopy or pHmetry (2F, 4M) underwent two 24-hour ambulatory MII/pH (Sandhill Scientific, Inc.) studies, first after two weeks of baclofen 20 mg TID, then after 2 weeks of esomeprazole 40 mg PO QD. Tracings analyzed for: a) number of acid (pH <4.0 for at least 5 sec) and nonacid (MII-detected volume reflux without accompanying pH <4.0) reflux episodes, b) esophageal acid exposure time (minutes with pH < 4.0 during study). Results: Six GERD patients (2F, 4M, mean age = 55) studied so far. Results summarized in the table. The total number of reflux episodes was similar with both medications. Predominant type of reflux was acid with baclofen, and nonacid with ESO. Acid exposure decreased with esomeprazole, but not significantly (possible type II error). Conclusions: Esomeprazole and baclofen both decrease total reflux episodes buth they affect the pattern of acid and nonacid reflux differently. or other GABA B agonists such Baclofen may have a role in the treatment of GERD; their use for persistent symptoms due to nonacid reflux warrants further study.[figure 1]Figure