Efficacy of Baclofen as Add-on Therapy for Refractory Gastroesophageal Reflux Disease

Abstract

Objectives: As a GABAB receptor agonist, baclofen has demonstrated efficacy in alleviating symptoms of refractory gastroesophageal reflux disease (r-GERD). This meta-analysis aims to evaluate the safety and effectiveness of baclofen as an add-on therapy for this condition. Method: We conducted a comprehensive search of the PubMed, Embase, and Web of Science databases for studies published up until October 2023. Subsequently, we performed a meta-analysis encompassing all eligible trials. Results: From 719 records, 10 studies were included, most of these studies were moderate risk. The findings demonstrated that the addition of baclofen as a supplementary treatment effectively improves symptoms (GERD Q score) in r-GERD (standardized mean difference=−0.78, 95% CI: −1.06 to −0.51, I 2=0%). The addition of this treatment also resulted in a decrease in the frequency of nonacidic reflux episodes (standardized mean difference=−0.93, 95% CI: −1.49 to −0.37, I 2=63%) and an improvement in DeMeester scores (standardized mean difference=−0.82, 95% CI: −1.61 to −0.04, I 2=81%) among patients with r-GERD when compared with the use of proton pump inhibitor (PPI) drugs alone. However, no significant disparity was observed in terms of reducing acid reflux episodes (standardized mean difference=−0.12, 95% CI: −0.49 to 0.19, I 2=0%) and proximal reflux (standardized mean difference=−0.47, 95% CI: −1.08 to 0.14, I 2=60%). Conclusion: Baclofen as an add-on treatment can effectively improve the symptoms of patients with r-GERD and reduce the incidence of nonacidic reflux and improve DeMeester score. However, long-term use of baclofen leads to an increased incidence of side effects and is not effective in reducing the occurrence of acid reflux.