Does baclofen (GABA receptor agonist) have a role in managing aerophagia?

Role of Baclofen in Managing Aerophagia

Baclofen is an effective treatment option for patients with aerophagia, particularly when it presents with symptoms of supragastric belching or rumination. 1, 2

Mechanism of Action and Evidence

• Baclofen is a GABAB receptor agonist that increases lower esophageal sphincter pressure and decreases swallowing rate, which helps reduce air swallowing and subsequent belching 2
• Clinical studies have shown that baclofen significantly reduces the number of flow events (including aerophagia) by approximately 40% compared to baseline measurements 2
• The American Gastroenterological Association recognizes baclofen as a treatment option specifically for belching disorders related to supragastric belching and aerophagia 1

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 1
• For proper diagnosis and differentiation from other belching disorders, ambulatory impedance monitoring with or without high-resolution manometry is recommended 1

Dosing and Administration

• The Clinical Gastroenterology and Hepatology society recommends baclofen for regurgitation or belch-predominant symptoms 1
• A typical dosing regimen is 10 mg three times daily, which has been shown to be effective in clinical studies 2
• Starting with a lower dose and gradually increasing is recommended to minimize common side effects 1

Clinical Benefits

• Baclofen treatment has been shown to reduce symptom markers for belching from a median of 10 (range 4-25) to 3 (range 1-15) and regurgitation from 9 (range 0-11) to 1 (range 0-13) 2
• The reduction in flow events correlates with the increase in lower esophageal sphincter pressure (r = -0.62) and reduction in swallowing frequency (r = 0.64) 2

Potential Side Effects and Precautions

• Common side effects include dizziness, somnolence, and gastrointestinal discomfort 1, 3
• Baclofen may inhibit swallowing function through central mechanisms, which should be considered when prescribing to patients with existing swallowing difficulties 4, 5
• Baclofen can cause significant central nervous system effects, so caution is advised when prescribing to elderly patients or those with impaired renal function 3

Alternative Approaches

• For some patients with chronic belching due to aerophagia, behavioral approaches such as diaphragmatic breathing techniques may be effective and can be considered either as an alternative or adjunct to baclofen therapy 6
• In cases where baclofen is not tolerated or contraindicated, behavioral therapy focusing on sustained glottal opening and diaphragmatic breathing may provide relief 6

Monitoring and Follow-up

• Patients should be monitored for improvement in symptoms as well as potential side effects 1
• If side effects are problematic, dose reduction may be necessary while maintaining therapeutic effect 3
• Abrupt discontinuation of baclofen should be avoided due to potential withdrawal symptoms, particularly in patients who have been on higher doses for extended periods 3