A
Here’s a clear overview of baclofen use for rumination syndrome, especially in children and adolescents, based on available clinical evidence and guidelines:
🔹 Background
-
Rumination syndrome = recurrent, effortless regurgitation of recently ingested food, typically within minutes of eating.
-
First-line therapy: behavioral interventions (diaphragmatic breathing, habit-reversal).
-
Pharmacological therapy is considered when behavioral therapy is insufficient or unavailable.
🔹 Baclofen: Mechanism
-
Baclofen is a GABA-B receptor agonist.
-
It reduces transient lower esophageal sphincter relaxations (TLESRs), which are implicated in rumination.
-
It also increases lower esophageal sphincter (LES) pressure and may reduce reflux/rumination events.
🔹 Evidence
Adults
-
Randomized controlled trial (Tack et al., 2011, Gastroenterology):
-
16 adults with rumination syndrome.
-
Baclofen 10 mg three times daily (TID) vs placebo for 2 weeks.
-
Result: Significant reduction in regurgitation episodes and increased LES pressure.
-
Children
-
Retrospective pediatric series (Gottrand et al., J Pediatr Gastroenterol Nutr, 2017):
-
Baclofen (10 mg TID) was associated with improvement in rumination symptoms.
-
Often combined with behavioral therapy.
-
-
Case reports/series: Show benefit in both rumination syndrome and refractory GERD.
🔹 Dosing (used in studies/clinical reports)
-
Adults:
-
10 mg TID (total 30 mg/day).
-
Sometimes titrated to 20 mg TID if tolerated.
-
-
Children/adolescents (based on case series, not formal guidelines):
-
5–10 mg TID, adjusted for weight/age.
-
Typically started at the lower end and titrated.
-
🔹 Safety & Side Effects
-
Common: Drowsiness, dizziness, fatigue, nausea.
-
Less common but important: Confusion, hypotonia, seizures (esp. if withdrawn suddenly).
-
Monitoring: Watch for sedation and neuropsychiatric effects; avoid abrupt discontinuation.
🔹 Guideline/Expert Opinion
-
NASPGHAN/ESPGHAN and ACG:
-
Baclofen may be considered as an adjunct in refractory cases of rumination or GERD, but behavioral therapy remains first-line.
-
Use is off-label in both children and adults.
-
✅ Summary:
Baclofen (typically 10 mg TID in adults, 5–10 mg TID in children) has been shown in small trials and case series to reduce regurgitation episodes in rumination syndrome by increasing LES tone and decreasing reflux. It is off-label and considered adjunctive therapy when behavioral therapy alone is insufficient. Careful monitoring for sedation and neurologic side effects is essential.
👉 Would you like me to draft a practical NHS-style treatment algorithm for rumination syndrome, showing when to use behavioral therapy, baclofen, or other interventions?
No comments:
Post a Comment