Abstract
IntroductionSome patients with GORD develop ETW referred to as GE(GORD-Erosion group) whereas others don’t and these are referred to as GNE(GORD-no-erosion group).The latest gold standard reflux monitoring is impedance-pH monitoring to identify the type of reflux and correlate the symptoms to each type of reflux. Basic Erosive Tooth Wear Examination (BEWE) is a scoring system to classify the affected tooth surfaces. This study used these two techniques which have not been used previously aiming to assess the risk factors and predictive values associated with presence of ETW in patients with GORD.MethodsPatients referred for assessment of GORD to the Oesophageal Laboratory at Guy’s Hospital were recruited (REC Ref 18/NE/0099). Participants were consented and given a validated Reflux Symptom Questionnaire 7-day recall (RESQ) to assess the frequency and intensity of GORD symptoms. Data reported from the impedance results were: total acid exposure, acid exposure in upright position and acid exposure in supine position. A clinical assessment of ETW was done using BEWE; a validated index dividing the mouth into 6 areas and each is scored from 0 to 3 (0=no ETW,1= initial loss of surface texture,2=loss of hard tissue <50% of surface area and 3=loss of hard tissue ≥50% of surface area). Those with a cumulative score of ≥12 and at least 1 oral area scoring 3 were included in the GE-group opposed to those scoring <12 were included in the GNE-group.Data were not normally distributed and hence median(IQR), Kruskal-Wallis and ROC curve were applied,(P<o.o5) considered significant.ResultsRESQ-7: 151 GORD patients recruited: GE(n=76), GNE(n=75). Median(IQR) frequency and intensity of GORD for hoarseness, cough and difficulty swallowing were significantly different between groups: frequency[GNE:7(2,11.5) and GE:12.5(2,17.5);P=0.007], intensity[GNE:4(2,7)and GE:6.6(3,10);P=0.006]. ROC curve for the total frequency and intensity illustrates that patients with total frequency an intensity of ≥26 and ≥37 most probably will have ETW, respectively.Impedence-pH-monitoringpatients reported: heartburn, chestpain, regurgitation, cough, hoarseness, acid taste in the mouth, throat acid, belching and epigastric pain, with no statistical significance between the GE and GNE groups. Total acid exposure and acid exposure in upright position were highly significant when comparing GE(n=53) and GNE(n=56)(P=0.0007).ConclusionThe risk of developing ETW is frequency score of 26 and above using the RESQ-7 and intensity score of 37 and above. Hoarseness, coughing and difficulty in swallowing were the significant risk factors for presence of ETW in patients with GORD. These atypical symptoms of GORD may indicate the presence of acid higher up in the oesophagus and therefore more likelihood of acid reaching the mouth.