Brief Article
Copyright ©2013 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Jul 21, 2013; 19(27): 4386-4392
Published online Jul 21, 2013. doi: 10.3748/wjg.v19.i27.4386
Therapeutic efficacy of baclofen in refractory gastroesophageal reflux-induced chronic cough
Xiang-Huai Xu, Zhong-Min Yang, Qiang Chen, Li Yu, Si-Wei Liang, Han-Jing Lv, Zhong-Min Qiu
Xiang-Huai Xu, Zhong-Min Yang, Qiang Chen, Li Yu, Si-Wei Liang, Han-Jing Lv, Zhong-Min Qiu, Department of Respiratory Medicine, Tongji Hospital, Tongji University School of Medicine, Shanghai 200065, China
Author contributions: Xu XH recruited the patients, performed experiments and statistical analysis of data, and wrote the manuscript; Yang ZM, Chen Q, Yu L, Liang SW and Lv HJ took part in the recruitment of patients and review of the manuscript; Qiu ZM designed and coordinated the program, and revised the manuscript.
Supported by National Natural Science Foundation of China, No. 81170079; Shanghai Shenkang Hospital Development Center Project, No. SHDC12012211
Correspondence to: Dr. Zhong-Min Qiu, Department of Respiratory Medicine, Tongji Hospital, Tongji University School of Medicine, No. 389 Xincun Road, Shanghai 200065, China. qiuzhongmin@tongji.edu.cn
Telephone: +86-21-66111286 Fax: +86-21-56050502
Received: February 6, 2013
Revised: May 3, 2013
Accepted: June 5, 2013
Published online: July 21, 2013
Abstract

AIM: To evaluate the efficacy and safety of baclofen for treatment of refractory gastroesophageal reflux-induced chronic cough (GERC) unresponsive to standard anti-reflux therapy.

METHODS: Sixteen patients with refractory GERC were given an 8-wk course of baclofen 20 mg three times a day as an add-on therapy to omeprazole. Changes in the cough symptom score, cough threshold to capsaicin, reflux symptom score and possible adverse effects were determined after treatment. The variables of multi-channel intraluminal impedance combined with pH monitoring were compared between responders and non-responders to baclofen.

RESULTS: Twelve of 16 patients completed treatment. Cough disappeared or improved in 56.3% (9/16) of patients, including 6 patients with acid reflux-induced cough (66.7%) and 3 patients with non-acid reflux-induced cough (33.3%). With baclofen treatment, the cough symptom score began to decrease at week 2, was clearly decreased at week 6 and reached a minimum at week 8. At the end of therapy, the lowest concentration of capsaicin required for induction of ≥ 2 and ≥ 5 coughs increased from 0.98 (1.46) to 1.95 (6.82) μmol/L (Z = -2.281, P = 0.024) and from 1.95 (7.31) to 7.8 (13.65) μmol/L (Z = -2.433, P = 0.014), respectively, and the reflux symptom score decreased from 8.0 ± 1.6 to 6.8 ± 0.8 (t = 2.454, P = 0.023). The number of acid reflux episodes was significantly lower in responders than in non-responders. The main adverse effects were somnolence, dizziness and fatigue.

CONCLUSION: Baclofen is a useful, but suboptimal treatment option for refractory GERC.

Keywords: Baclofen, Cough, Esophageal pH monitoring, Gastroesophageal reflux, Proton pump inhibitors

Core tip: This study evaluated the efficacy and safety of baclofen in a cohort of patients with refractory gastroesophageal reflux-induced chronic cough (GERC) unresponsive to 8 wk of standard anti-reflux therapy consisting of omeprazole twice daily and domperidone. Baclofen is found to be a useful, but suboptimal treatment option for refractory GERC.