ABSTRACT
BACKGROUND: Baclofen, a GABA(B) agonist, has been shown to reduce transient lower oesophageal sphincter relaxations (TLESRs), a major cause of gastro-oesophageal reflux disease (GERD). AIM: To examine the effect and tolerability of baclofen in GERD patients over a 2-week period. METHODS: Forty-three GERD patients with abnormal 24-h pH tests were prospectively randomised to receive baclofen or placebo in a double-blind fashion for 2 weeks. Oesophageal manometry, 24-h pH monitoring, and a standard questionnaire was administered, before and after treatment. RESULTS: Thirty-four patients completed the study. In the baclofen group there were significant decreases in 24-h pH score (P = 0.020), percent of upright reflux episodes (P = 0.016), percent total time pH <4 (P = 0.003), number of reflux episodes (P = 0.018), number of reflux episodes longer than 5 min (P = 0.016), number of postprandial reflux episodes (P = 0.045), and percentage of time pH <4 (P = 0.003). No significant changes in reflux parameters were noted in the placebo group. Patients receiving baclofen had significantly less belching (P = 0.038), regurgitation (P = 0.036) and overall symptom score (P = 0.004) whereas placebo patients had less heartburn (P = 0.001), chest pain (P = 0.002), regurgitation (P = 0.017) and overall symptom score (P = 0.000). However, there were no significant differences in changes of reflux parameters or symptoms when comparing the two groups. Drowsiness did not limit baclofen use. CONCLUSIONS: Baclofen was associated with a significant decrease in percent upright reflux by 24-h pH monitoring and a significant improvement in belching, regurgitation and overall symptom score. Baclofen may be more effective in patients with predominantly upright reflux and belching.
Subject(s)
Baclofen/therapeutic use , GABA-B Receptor Agonists/therapeutic use , Gastroesophageal Reflux/drug therapy , Adult , Baclofen/pharmacology , Chest Pain/drug therapy , Chest Pain/etiology , Double-Blind Method , Eructation/drug therapy , Eructation/etiology , Esophageal pH Monitoring , Female , GABA-B Receptor Agonists/pharmacology , Gastroesophageal Reflux/physiopathology , Heartburn/drug therapy , Heartburn/etiology , Humans , Hydrogen-Ion Concentration , Male , Manometry , Middle Aged , Postprandial Period , Prospective Studies , Treatment OutcomeABSTRACT
Congenital bronchoesophageal fistula is a rare anomaly that may go undiagnosed for many years. There are <200 reported cases in the literature. Patients usually present with chronic cough, a history of multiple pneumonias, and, less often, hemoptysis. The most sensitive test to diagnose a bronchoesophageal fistula is barium esophagogram. Surgical resection is the treatment of choice and is definitive in almost all cases. We present the case of a 52-yr-old woman with a history of cough and multiple pneumonias who sought medical treatment for abdominal pain. We discuss the presentation and the radiographic, endoscopic, and surgical findings, along with a review of the literature.
