Abstract
Background
Baclofen can decrease rumination frequency in adults with rumination syndrome. Outcomes of baclofen treatment in children with rumination syndrome have not been described. The aim of this study was to examine the safety and efficacy of baclofen in children with rumination syndrome in combination with behavioral therapy at a single center.
Methods
We performed a retrospective review of children aged 0–18 years with rumination syndrome based on Rome criteria and prescribed baclofen by a pediatric gastroenterologist at the Nationwide Children’s Hospital, Columbus, Ohio, USA, between 2012 and 2019. Children without follow-up data or who were prescribed baclofen for other symptoms were excluded.
Results
We identified 44 children with rumination syndrome who were prescribed baclofen by a pediatric gastroenterologist. Seventeen either did not have follow-up data or never started the medication. We included 27 patients in the study: 22 (81.5%) female, median age 14.5 years (range 10–18 years) and 100% Caucasian. Twenty patients (74%) received baclofen 5 mg and seven patients (26%) received baclofen 10 mg three times daily. Most patients received behavioral therapy and baclofen simultaneously. Thirteen patients (48%) reported improvement in symptoms, primarily a decrease in rumination frequency, at their first follow-up visit. Regurgitation frequency per week decreased after starting baclofen (p < 0.05). One patient experienced dizziness. No other side effects were reported.
Conclusion
Nearly half of our patients with rumination syndrome improved after baclofen. It was well tolerated with minimal side effects. This suggests that baclofen in addition to behavioral therapy can improve symptoms of rumination syndrome. Prospective, controlled studies in a larger cohort of children with rumination syndrome are needed to confirm these findings.
Similar content being viewed by others
References
Hyams JS, Di Lorenzo C, Saps M, et al. Functional disorders: children and adolescents. Gastroenterology. 2016;S0016–5085(16):00181–5.
Absah I, Rishi A, Talley NJ, et al. Rumination syndrome: pathophysiology, diagnosis, and treatment. Neurogastroenterol Motil. 2017;29(4):e12954.
Lee H, Rhee PL, Park EH, et al. Clinical outcome of rumination syndrome in adults without psychiatric illness: a prospective study. J Gastroenterol Hepatol. 2007;22:1741–7.
Olden KW. Rumination. Curr Treat Opt Gastroenterol. 2001;4:351–8.
Kessing BF, Smout AJ, Bredenoord AJ. Current diagnosis and management of the rumination syndrome. J Clin Gastroenterol. 2014;48:478–83.
Mousa HM, Montgomery M, Alioto A. Adolescent rumination syndrome. Curr Gastroenterol Rep. 2014;16:398.
Kessing BF, Bredenoord AJ, Smout AJ. Objective manometric criteria for the rumination syndrome. Am J Gastroenterol. 2014;109:52–9.
Rosen R, Rodriguez L, Nurko S. Pediatric rumination subtypes: a study using high-resolution esophageal manometry with impedance. Neurogastroenterol Motil. 2017;29:e12928.
Halland M, Parthasarathy G, Bharucha AE, et al. Diaphragmatic breathing for rumination syndrome: efficacy and mechanisms of action. Neurogastroenterol Motil. 2016;28:384–91.
Schroedl RL, Di Lorenzo C, Alioto A. Adolescent rumination syndrome. Pediatr Ann. 2014;43:e95–100.
Lamparyk K, Stephens TN. Protocol and outcome evaluation of comprehensive outpatient treatment of adolescent rumination syndrome. J Pediatr Gastroenterol Nutr. 2022;75(3):e38–42.
Lehmann A. Novel treatments of GERD: focus on the lower esophageal sphincter. Eur Rev Med Pharmacol Sci. 2008;12(Suppl 1):103–10.
Warren RL, Davis SM. The role of baclofen in the treatment of gastroesophageal reflux disease. J Pharm Technol. 2015;31:258–61.
Blondeau K, Boecxstaens V, Rommel N, et al. Baclofen improves symptoms and reduces postprandial flow events in patients with rumination and supragastric belching. Clin Gastroenterol Hepatol. 2012;10:379–84.
Pauwels A, Broers C, Van Houtte B, et al. A randomized double-blind, placebo-controlled, cross-over study using baclofen in the treatment of rumination syndrome. Am J Gastroenterol. 2018;113:97–104.
Miller C, Twillman R, Foran P, et al. Gastric emptying results in conditioned vomiting disorder: the concept of a primary entity as well as learned reflex. J Investig Med. 2008;56:436.
Alioto A, Di Lorenzo C. Long-term follow-up of adolescents treated for rumination syndrome in an inpatient setting. J Pediatr Gastroenterol Nutr. 2018;66:21–5.
Green AD, Alioto A, Mousa H, et al. Severe pediatric rumination syndrome: successful interdisciplinary inpatient management. J Pediatr Gastroenterol Nutr. 2011;52:414–8.
Acknowledgements
This data has been previously presented at the annual meeting of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) in December 2021.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflicts of interest
The authors declare that they have no conflicts of interest.
Funding
There was no funding for this research project.
Ethics approval
Not applicable.
Consent to Partcipate
Not applicable.
Consent to Publish
Not applicable.
Code availability
Not applicable.
Data availability
The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.
Author contributions
SG and NB planned and conducted the study, SG collected and interpreted the data and drafted the manuscript, NB interpreted the data and drafted the manuscript. DY, PL, KV, JW, AKVD, CD assisted in designing the study and critically revising the manuscript. NB also critically revised the manuscript.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Gupta, S.R., Lu, P.L., Vaz, K.H. et al. A Retrospective Review of Baclofen Treatment for Children with Rumination Syndrome at a Single Center. Pediatr Drugs 25, 359–363 (2023). https://doi.org/10.1007/s40272-023-00567-w
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s40272-023-00567-w