GI Symptoms & Novel Therapy

Do you have lots of different gastrointestinal (GI) symptoms? Could they be associated with your widespread pain or fatigue severity? Do you wonder which specific GI symptoms are most common in people with fibromyalgia? And perhaps most importantly, what are your treatment options?

A published report by a Turkish team compared the frequency of various GI symptoms in 152 fibromyalgia patients to those found in 98 people with rheumatoid arthritis (RA) and 60 healthy controls.¹ They looked at the widespread pain and fatigue severity scores in each group to determine if any GI symptoms occurred more often when higher pain or fatigue levels were present. The research team also wanted to find out if patients who took medication use for treating acid reflux (e.g., gastro-protective agents such as proton pump inhibitors like Prilosec) had reduced GI symptoms.

Although RA is a chronic painful illness, the symptom severity scores for widespread pain and fatigue were almost twice as bad for patients in the fibromyalgia group. Functional impairment, morning tiredness, and sleep disturbance were also worse for the fibromyalgia group compared to those with RA. So it should be no surprise that the GI symptoms occurred with a greater frequency in the fibromyalgia group and caused an increased disruption in quality of life.

The most commonly reported GI symptoms in the fibromyalgia patients were belching, acid reflux, gas and bloating, sour taste, and vomiting. For the most part, the various GI symptoms intensified as the widespread pain and fatigue severity scores increased. Yet, there was no difference in GI symptom severity between the fibromyalgia patients who took gastro-protective agents versus those who did not. It would seem that the proton pump inhibitor agents that were taken by one-third of the patients were not very effective for soothing the painful symptoms of acid reflux.

Is there another type of medication that might be useful for treating acid reflux? Possibly. A preliminary study using an old and inexpensive drug, baclofen, showed it effectively cut the number of nighttime acid reflux events by 65 percent.² This, in turn, led to a significant improvement in the quality of sleep because the small group of 13 study participants experienced fewer reflux episodes that interfered with their sleep.

Baclofen is a heavily sedating drug, which limits daytime use. However, the supine position of sleep makes acid reflux much worse, so nighttime treatment may be most effective. The subjects in this study took 40 mg of baclofen 90 minutes before bedtime. Given that fibromyalgia patients are known to be drug sensitive, a lower dose of 10 mg should be tried initially on a night that you do not have to get up and go the next morning. According to the Oklahoma City research team, baclofen works by reducing the tendency of the cardiac sphincter, or valve, between the esophagus and the top of the stomach, to open. In normal people, this valve prevents the back flow of acid up into the esophagus.

1. Pamuk ON, et al. J Rheumatol [Epub ahead of print] July 1, 2009.
2. Orr WC, et al. SLEEP 2009, Abstract 1030, Associated Professional Sleep Societies, LLC, Seattle, WA.