Lower oesophageal sphincter pressure, length peg baclofen efficacy in refractory GERC

In the treatment of refractory gastroesophageal reflux-induced chronic cough (GERC), the lower oesophageal sphincter pressure (LESP) and lower oesophageal sphincter length (LESL) help predict baclofen efficacy, according to a study.

The analysis included 138 patients with suspected refractory GERC who received baclofen. All patients underwent oesophageal manometry and multichannel intraluminal impedance-pH monitoring prior to the treatment.

Baclofen treatment yielded an overall response rate of 52.2 percent (n=72). A stepwise logistic regression analysis revealed that response was associated with LESP (odds ratio [OR], 0.592; p=0.000) and LESL (OR, 0.144; p=0.008).

At a cutoff point of 11.00 mm Hg, LESP was able to predict baclofen efficacy with a sensitivity of 83.7 percent and specificity of 79.1 percent. On the other hand, the optimal cutoff point for LESL was 2.35 cm, with a sensitivity of 81.6 percent and specificity of 72.1 percent.

The combination of LESP and LESL yielded the highest predictive specificity at 90.7 percent.

Baclofen has been reported to have suboptimal therapeutic efficacy in patients with refractory GERC. As such, LESP and LESL may prove useful when screening patients suitable for baclofen therapy and, in turn, help improve the therapeutic precision.

Reflux-induced cough unresponsive to standard medical antireflux treatment but responsive to the subsequent intensified antireflux therapy. This condition may be linked to the residual acid or nonacid reflux, transient lower oesophageal sphincter relaxations, and oesophageal hypersensitivity. GERC may be treated with complete acid suppression and add-on baclofen or gabapentin. [World J Methodol 2015;5:149-156]