Gastroesophageal reflux disease and baclofen: is there a light at the end of the tunnel?

Transient lower esophageal sphincter relaxations (TLESRs) are rapid and prolonged relaxations of the lower esophageal sphincter (LES) that are not associated with swallowing. They are the mechanism by which most gastroesophageal reflux episodes occur in normal people and in patients with esophagitis. Transient LES relaxations appear to be mediated by a vagovagal reflex initiated by gastric distention. Baclofen is a g-aminobutyric acid (GABA) derivative that inhibits the production of TLESRs by acting as a GABA(B) receptor agonist at one or more loci along the vagovagal reflex arc. Animal and human studies suggest that baclofen decreases the number of reflux events and amount of esophageal acid exposure. Baclofen or another GABA(B) receptor agonist may be clinically useful in treatment of gastroesophageal reflux disease.