How does baclofen help with aerophagia?

How Baclofen Helps with Aerophagia

Baclofen effectively treats aerophagia by reducing transient lower esophageal sphincter relaxations (TLESRs) and decreasing swallowing frequency, which prevents excessive air from entering the digestive tract. 1

Mechanism of Action

• Baclofen is a GABA-B receptor agonist that increases lower esophageal sphincter (LOS) pressure and decreases the rate of swallowing, directly addressing the physiological mechanisms of aerophagia 1
• By reducing TLESRs, baclofen prevents the involuntary relaxation of the LOS that allows air to enter the esophagus and stomach 2
• The drug maintains increased LOS basal tone throughout a 24-hour period, not just after meals, providing continuous protection against air swallowing 2

Clinical Evidence for Efficacy

• High-resolution manometry-impedance studies have demonstrated that baclofen significantly reduces the number of flow events related to aerophagia (from 42 to 13 events in one study) 1
• Baclofen treatment resulted in a significant reduction in symptom markers for belching (from an average of 10 to 3) and regurgitation (from 9 to 1) 1
• The American Gastroenterological Association recognizes baclofen as a treatment option for belching disorders, particularly when related to supragastric belching and aerophagia 3

Diagnostic Considerations

• Aerophagia should be suspected when manometry shows influx of air into the esophagus with swallowing, causing intestinal gas accumulation visible on abdominal X-rays 3
• To differentiate types of belching (which may be related to aerophagia), ambulatory impedance monitoring with or without high-resolution manometry is recommended, with 24-hour impedance being preferred 3

Dosing and Administration

• The typical dosing regimen for baclofen in treating aerophagia is 10 mg three times daily 1, 4
• The Clinical Gastroenterology and Hepatology society recommends baclofen for regurgitation or belch-predominant symptoms in GERD management 4
• Starting with a low dose and gradually increasing is recommended to minimize common side effects such as dizziness, somnolence, and gastrointestinal discomfort 4

Safety Profile and Side Effects

• Most reported side effects of baclofen are mild-to-moderate in intensity, and the drug is generally well tolerated 5
• Common side effects include dizziness, somnolence, and gastrointestinal symptoms 4
• No serious adverse events were reported in studies examining baclofen for reflux and belching disorders 5

Alternative Approaches

• For patients who cannot tolerate baclofen, behavioral approaches based on diaphragmatic breathing with mouth slightly open can be effective for chronic belching related to aerophagia 6
• This technique prevents glottic closure necessary for belching and can be taught as an office-based procedure 6

Clinical Applications Beyond Aerophagia

• Baclofen has shown efficacy in treating related conditions such as supragastric belching, rumination syndrome, and GERD 1, 5
• The drug has also demonstrated effectiveness for chronic hiccups, which may share some pathophysiological mechanisms with aerophagia 7

When treating aerophagia with baclofen, monitor patients for symptom improvement and potential side effects, particularly in the first few weeks of treatment. The significant reduction in air swallowing events correlates directly with the increase in LOS pressure and reduction in swallowing frequency, providing a clear physiological basis for its effectiveness.