GERD

Case: 34 year old healthy male is admitted to ICU with confusion and trembling. CT scan done in ED is negative. Wife informed that the only positive past medical history (PMH) is of Gastro-Esophageal-Reflux-Disease (GERD) which was not getting improved with Proton-Pump-Inhibitors (PPIs) and recently his physician prescribed him a new medicine as a four weeks trial. What medicine is highly suspected?


Answer: Baclofen.

Baclofen is frequently used as a second line treatment particularly in non-acid reflux GERD as a trial. Baclofen reduces the incidence of transient lower esophageal sphincter relaxation. Baclofen crosses the blood-brain barrier, and may result in symptoms like somnolence, confusion, drowsiness, and trembling. This side effect is a major barrier to the use of baclofen in the treatment of GERD. It should be started at a lower dose and titrated up while watching the side effects. A trial of 4 to 8 weeks seems appropriate.

#pharmacology
#gastroenterology
#neurology


References:

1. Shujie Li, Shengying Shi, Feng Chen, and Jingming Lin. Review Article The Effects of Baclofen for the Treatment of Gastroesophageal Reflux Disease: A Meta-Analysis of Randomized Controlled Trials Gastroenterology Research and Practice Volume 2014, Article ID 307805, 8 pages http://dx.doi.org/10.1155/2014/307805

2. Vela MF, Tutuian R, Katz PO, Castell DO. Baclofen decreases acid and non-acid post-prandial gastro-oesophageal reflux measured by combined multichannel intraluminal impedance and pH. Aliment Pharmacol Ther 2003; 17:243. 

3. Koek GH, Sifrim D, Lerut T, et al. Effect of the GABA(B) agonist baclofen in patients with symptoms and duodeno-gastro-oesophageal reflux refractory to proton pump inhibitors. Gut 2003; 52:1397.