Tooth wear in gastroesophageal diflux disease (GERD)

Tooth wear in gastroesophageal diflux disease (GERD)

undergoing preoperative evaluation (58%) or investigation of refractory reflux symptoms (42%). Physiologicalresults as well as symptom diaries and sel...

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undergoing preoperative evaluation (58%) or investigation of refractory reflux symptoms (42%). Physiologicalresults as well as symptom diaries and self-report symptom scalescores were used to determinesymptom intensity (heartburn, chest pain), esophagealacid exposure time (TAET), reflux-associatedsymptoms (RAS), symptom index (SI), and acid sensitivity (AS: RAS/TAET)in relation to motor pattern. RESULTS:91 (42%) had SMDs whereas the remainder had other patterns (normal, 31%; hypomotillty, 27%). Symptoms reported by SMD patients were of similar magnitude as symptoms in other patients, but TAET was lower in the former (7.1 -+0.6% vs. 9.4 -+0.9%; p
Esophagealperistalsis Value

Units

Smoker

Non-smoker

P-value

Amplitude (Upper) Amplitude (Mid) Amplitude (Low) Velocit7

mmHg

46.2

40.0

.000

mmHg

61.7

53.5

.001

mmHg

67.1

60.5

.006

cm/s

3.4

3.0

.000

2187 The Significance Of Plateau Pressure In A Hiatal Hernia Noted On Esophageal Manometry Nagammapudur S. Balaji, ShahjehanA. Waled, Cedric G. Bremner, Christopher G. Streets, Peter I. Tsai, FarzanehBanki, Duff M. Bruce, Steven R. DeMeester,Jeffrey A. Hagen, Peter F. Crookes, Lelan F. Sillin, RodneyJ. Mason, Jeffrey H. Peters, Tom R. DeMeester,Univ of Southern CA, Los Angeles, CA INTRODUCTION:The presenceof a hiatal hernia is a common finding in many patients with gastro-esophageal reflux disease (GERD). Large hernias are associated with more severe disease. Hiatal hernia in esophagealmanometry is manifested by a double hump. The plateau pressure betweenthe two humps is a marker of pressurizationwithin the sac. We hypothesize that the magnitude of the plateau pressure influences the severity of reflux. METHODS:25 consecutive patients referred for evaluation of symptomatic GERD with the presence of a double hump on esophagealmanometry and hiatal hernias greater than 2cm on endoscopy were studied. All the patients had endoscopy, esophagealmanometry, 24hr pH scores and a barium video esophagogram.The medianplateaupressurewas calculatedfrom a manometric motorized puff through. The relationships betweenthe plateaupressure,the LES components, hernia length and esophagealacid exposurehave beenstudied. RESULTS:The median plateau pressure was 8 mm of Hg (range 2-18). There was an inverse relationship (r= - 0.526, p
2190 Untreated or Poorly Treated GERD Is Common in Obstrudive Sleep Apnea and Is Associated with Decreased Quality of Life. Nalini Guda, Lyndon Hernandez,Nimish Vakil, Univ of Wisconsin, Milwaukee, WI Obstructive sleep apnea is a common condition associatedwith serious complications such as pulmonary hypertension, congestive heart failure, etc., The aim of this study was to determine the prevalenceof GERD symptoms in patients with proven sleep apnea and to determine if the severity of sleep apnea and quality of life was related to the presence of GERD. METHODS:101 patients undergoing sleep studies were evaluated.GERD symptoms were measured using a validated scale (Gastrointestinal Symptom Rating scale or GSRS). Patients underwentstandardovernight polysomnngraphy.Individualshavingan Apnea/Hypopnea index (A~I) oi >15 were considered to have obstructive sleep apnea (OSA). Quality of life was measured by using a serf-reported, validated instrument, the Calgary Sleep Apnea Quality of Life Index (SAQLI). RESULTS: Mean-+SD. There were 58 females and 43 males and their ages rangedfrom 21 78 years (mean 47 years). 89 of them were obese (BMt >29), 8 were overweight (8MI 25 29) and 4 had a normal BMI <25. Sleep apnea was diagnosed in 71 patients. GERD symptoms determined by the GSRS were present in 45/101 patients (44%) of the cohort. There was no statistically significant difference in the prevalenceof GERD symptoms (50%) in patients with OSA and those with mild or no apnea (33%). The odds ratio for severe sleep apnea in patients with moderate to severe reflux determined by the GSRS was 1.1 (5% CI: 0.4-3.2) compared to 0.85 (95%CI 0.24-2.9) in patients without reflux symptoms. 31patieots were taking acid inhibitory therapy and 15 of them still had moderate to severe GERDsymptoms (46%). The mean Sleep Apnea Quality of Life score in patients with GERDand obstructive sleepapneawas 2.8-+1.1 comparedto 3.9-+1.2 in patients with sleep apneawithout GERD.CONCLUSIONS:1.Patientswith obstructive sleep apneahave an unusually high prevalenceof GERD. 2. Most patients have unresolved symptoms despite therapy. 3. The impact of complete resolution of GERD symptoms on the severity of sleep apnea deservesfurther study. 4. Quality of life is impaired in obstructive sleep apnea and is worsened by the presence of GERD symptoms.

2188 ineffective Esophageal Meffl|ty And Esophageal Acid Exposure Martin Fein, KarI-Herrmann Fuchs, Gabor Varga, Stephan M. Frays, Joern Maroske, Harald Tigges, Marco Sailer, Arnulf Thiede, Dept of Surg, Wuerzburg Germany BACKGROUND: it has been recently suggested to classify nonspecific motility disorders as ineffective esophagealmotilify (IEM) when there are more than 30% 'ineffective' contraction waves, i.e., swallow contractions on manometrythat are either of low amplitude (<30 mmHg) or non peristaltic. The aim of the study was to evaluatewhether this definition is appropriate in our patient population with GERD and to quantify the effect of IEM on esophagealacid exposure. METHODS:700 patients with GERD (age: 48-+15 y; 430 male) had esophageal manometry and 24-pH monitoring in the esophageal function laboratory of our surgical departmentfrom 1/92 to 8/00. Peristalsiswas analyzedin 10 wet swallows with 5 ml of water according to the criteria for IEM. Hiatal hernia was present in 337 patients. 112 had Barrett's esophagus, 374 had erosive esophagitis, and 214 had no esophagealinjury. RESULTS:After classification of the patients according to the frequency of ineffective contractions (<20%, 20-30%, 30-40%, 40-50%, > 50%) it was found that the duration of the longest reflux episode was significantly increasingwhen there were more than 30% of ineffective contractions. IEM was not related to hiatal hernia and present in 24% of the patients. There was a significant effect of IEM especially on supine acid exposure and the duration of acid reflux episodes (table). CONCLUSION:The definition of tEM is useful to identify patients with prolonged acid reflux episodes. IEM is mainly related to a prolonged supine acid exposure and a longer duration of the reflux episodes. It cannot be determined from these data whether IEM is the cause or the effect of increasedesophagealacid exposure. ExposurepH <4

No IEM (n=533)

IEM (n=167)

P

Total % time Upright % time Supine% time Episodes> 5 min LongestEpisode

12,7±29.t 11.1_+12.8 10.8±22.1 5,2~5,7 26.9~33.7

15,6~16.6 13,815.4 17P+21,9 7,1±6,8 45.,%:76.2

n.s. 0.04 0.001 0.001 0.002

2191 Tooth Wear in Gastreesophageal Reflux Disease (GERD) Jose V. Munoz, Francisco Mora, Miguel Minguez, Vicente Sanchiz, Isabel Pascual, Pedro Almela, Andrea Pena, Belen Herreros, Vicente Hernandez,Paloma Lluch, Cirilo Amoms, Adoffo Benages, Dept of Gastroenterology,Univ Clin Hosp, Valencia Spain Hypothesis:Pathologicalgastro-esophagealreflux causestooth wear.Thistooth wear is related to the severity and patterns of reflux.Aims:To study the prevalenceof tooth wear in patients with GERDand its relation with some clinical characteristicsand esophagealpH data (severity and pattams).Methods: A prospective study. GERDgroup: 164 patients (65 M, 99 F; mean age 47,1-+13,5 years) with clinical symptoms of GERD who were evaluated by endoscopy, manometry and 24-hour esophagealpH monitoring. Control group (CG):70 healthy subject~ (22 M,48 F; mean age 44,5-+13,5 years)without GERD symptoms. The diagnosis of tooth wear in both groups was carried out by a dentist who did not Knowthe clinical and esophageal pH data of the patients. The relation of tooth wear with clinical features (time of evolution of heartburn, acid regurgitation and nocturnal respiratory symptoms) and pH-metric parameters (severity and reflux pattern)has been analyzedin GERD. Results:Therewere no differences between the two groups with regards to demographic characteristics, alcohol and tobacco consumption. In the CG, tooth wear was more frequent in older subjects(p
2189 Implications Of Spastic Motor Disorders In Patients With Reflux Symptoms Aydamir Alrakawi, Ray E. Clouse, Washington Uoiv, St. Louis, MO

Without tooth wear

BACKGROUND: Spastic motor disorders (SMDs), both nonspecffic spastic disorders and diffuse esophageal spasm, are detected during evaluation of GERD symptoms, but their relevance is not well established. They may represent epiphenomenaof GERD itself. This study examinedthe effect of esophagealmanometric pattern on symptom reporting in reflux patients referred for esophageal physiological studies. METHODS: Esophagealmanometry and ambulatory pH studies were reviewed from 218 patients (45 -+12yr; 65% females)

CG GERD

A-429

60 (86%) 88 (54%)

Worn teeth 1.4

>4

lO (14%)o 41 (25%)

o 35 (21%)