胃食管反流与侵蚀性牙齿磨损的纵向研究
Longitudinal study of gastroesophageal reflux and erosive tooth wear.
作者信息
Wilder-Smith Clive H, Materna Andrea, Martig Lukas, Lussi Adrian
机构信息
Brain-Gut Research Group and Gastroenterology Group Practice, Bubenbergplatz 11, -3011, Bern, CH, Switzerland.
Department of Preventive, Restorative and Pediatric Dentistry, University of Bern, Bern, Switzerland.
出版信息
BMC Gastroenterol. 2017 Oct 25;17(1):113. doi: 10.1186/s12876-017-0670-1.
BACKGROUND
Approximately 60% of patients presenting to dentists with erosive tooth wear have significant gastroesophageal reflux (GERD), despite minor reflux symptoms. No longitudinal studies of reflux-associated erosive tooth wear and of reflux characteristics have been reported to date. The aim of this study was to characterize the longitudinal course of GERD and of associated erosive tooth wear, as well as factors predictive of its progression, in a large group of patients.
METHODS
Seventy-two patients presenting to dentists with clinically significant erosive tooth wear and increased esophageal acid exposure by 24-h multichannel intraluminal pH-impedance measurement (MII-pH) were re-assessed clinically and by MII-pH after 1 year treatment with esomeprazole 20 mg twice-daily. Predictive factors for erosive tooth wear were assessed by logistic regression.
RESULTS
At follow-up, no further progression in erosive tooth wear was observed in 53 (74%) of patients. The percentage of time with a pH < 4, the number of acid reflux episodes and the percentage of proximal esophageal reflux off-PPI did not change significantly after one year, but the number of weakly acidic reflux episodes decreased significantly in the large subgroup without progression. None of the baseline demographic, clinical, endoscopic or esophageal acid exposure characteristics were significantly associated with progression of erosive tooth wear at follow-up.
CONCLUSIONS
In this longitudinal study in patients with erosive tooth wear and oligosymptomatic GERD receiving esomeprazole for one year, erosive tooth wear did not progress further in the majority of patients. Background acidic esophageal reflux exposure appeared stable over time, whereas weakly acidic exposure decreased significantly in patients without erosion progression. MII-pH measurements on-PPI and with healthy controls will be useful in the further elucidation of the causal role of reflux in erosive tooth wear.
TRIAL REGISTRATION
ClinicalTrials.gov , retrospectively registered: NCT02087345 .
背景
约60%因牙齿磨损而就诊于牙医处的患者存在明显的胃食管反流（GERD），尽管反流症状轻微。迄今为止，尚未有关于反流相关性牙齿磨损及反流特征的纵向研究报道。本研究的目的是在一大组患者中，描述GERD及其相关牙齿磨损的纵向病程，以及预测其进展的因素。
方法
72例因临床上明显的牙齿磨损且经24小时多通道腔内pH-阻抗测量（MII-pH）显示食管酸暴露增加而就诊于牙医处的患者，在接受每日两次20mg埃索美拉唑治疗1年后，进行临床及MII-pH重新评估。通过逻辑回归评估牙齿磨损的预测因素。
结果
随访时，53例（74%）患者的牙齿磨损未进一步进展。pH<4的时间百分比、酸反流发作次数以及停用质子泵抑制剂（PPI）后近端食管反流的百分比在1年后无显著变化，但在无进展的大亚组中，弱酸性反流发作次数显著减少。基线人口统计学、临床、内镜或食管酸暴露特征均与随访时牙齿磨损的进展无显著相关性。
结论
在这项针对牙齿磨损且GERD症状轻微的患者接受埃索美拉唑治疗1年的纵向研究中，大多数患者的牙齿磨损未进一步进展。背景性食管酸反流暴露随时间似乎稳定，而在无磨损进展的患者中，弱酸性暴露显著减少。PPI治疗时的MII-pH测量以及与健康对照的比较，将有助于进一步阐明反流在牙齿磨损中的因果作用。
试验注册
ClinicalTrials.gov，回顾性注册：NCT02087345 。
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