Читать книгу The Esophagus - Группа авторов - Страница 105

Diaphragmatic breathing is not always effective as a result of inability to learn the technique or assiduously use it postprandially. As a result, pharmacologic therapy can be tried. Two medications have been used for rumination syndrome: baclofen and buspirone. Baclofen is a g‐aminobutyric acid agonist that decreases the number of transient lower esophageal sphincter relaxations [20]. It has been primarily used in patients with refractory GERD [21]. It is used, similarly, in rumination syndrome to maintain greater periods of LES closure to prevent regurgitation of content. In an open‐label study, baclofen taken thrice daily led to a 63% improvement of symptoms in patients with rumination with a reduction in regurgitation events [22]. Unfortunately, side effects, particularly fatigue, are common with baclofen.

Buspirone is a 5‐hydroxytryptamine1A–receptor agonist. Its mechanism of action in rumination syndrome may be related to relaxation of the fundus and/or improvement of gastric compliance [23]. There are no placebo‐controlled trials of this agent in rumination syndrome, but through these mechanisms, efficacy might be achieved.