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Functional dyspepsia (FD) is a common gastrointestinal (GI) ailment that causes upper abdominal symptoms without structural disease. Chronic belching can occur with dyspepsia and may become difficult to treat with standard therapy.
A 40-year-old nulligravid woman presented with persistent belching, heartburn, early satiety, and occasional dry cough that progressively worsened, significantly affecting her daily activities and social interactions. Endoscopy showed a hiatal hernia and mild congestive gastropathy. Several treatments, including proton pump inhibitors and symptomatic medications, did not improve her condition. She was later treated with baclofen 10 mg. The patient experienced a marked reduction in belching frequency and severity, improvement in dyspeptic symptoms, and enhancement of quality of life (QoL).
This case highlights the potential role of baclofen in refractory FD with chronic belching, particularly in the presence of psychiatric comorbidity.
The female patient complained of chronic upper GI symptoms for about 18 months. The condition gradually worsened and led to social withdrawal.
Main symptoms included:
Her symptoms intensified during episodes of anxiety and depression. She denied experiencing weight loss, GI bleeding, anorexia, or significant weakness.
Introduction
FD is a disorder that causes upper abdominal discomfort without visible structural disease. Common symptoms include fullness, early satiety, epigastric discomfort, and belching. The condition is related to abnormal gut function and changes in the brain-gut interaction. Risk factors include:
Medical History
The patient had a medical history of:
Medication regimen included:
On physical assessment, the patient was in good general state with normal mucosal coloration and hydration. Her body mass index (BMI) was 28.9 kg/m². Oral and abdominal examinations were normal, and no alarming GI features were noted.
Upper GI endoscopy showed:
A diagnosis of FD with chronic belching was made after excluding structural disease.
Initial treatment included omeprazole 20 mg daily for one month without improvement. Other medications tried included:
Lifestyle recommendations included:
Due to persistent symptoms, baclofen 10 mg twice daily was started, which was chosen to help reduce belching and improve esophageal function.
Discussion
In this patient, extensive evaluation excluded significant organic disease. Conventional treatments, including proton pump inhibitors, mucosal protective agents, antifoaming agents, antihistamines, and prokinetics, failed to yield meaningful relief. The close temporal relationship between GI symptoms and psychological distress suggested a substantial brain-gut interaction component.
Baclofen, a GABA-B receptor agonist, reduces transient lower esophageal sphincter relaxations and suppresses excessive belching. Its introduction resulted in marked clinical improvement, supporting its potential role in selected patients with refractory dyspeptic symptoms, chronic belching, and psychiatric comorbidities. After commencing baclofen therapy:
No significant adverse effects were reported. This case highlights the importance of considering FD in patients with persistent upper GI symptoms after exclusion of organic disease. Baclofen appears to be a valuable therapeutic option for refractory chronic belching and dyspeptic symptoms, particularly in those with concomitant psychiatric disorders. A multidisciplinary biopsychosocial approach remains fundamental for successful management.
Learning
Cureus
Baclofen in Refractory Dyspepsia With Chronic Belching: A Case Report
Rocha M et al.
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