Su1054 Perception About Gastroesophageal Reflux Disease (GERD) and Its Impact on Daily Life in the General Population: Results From a Large Population Based AGA Survey

Abstract

Dental erosions are increasingly recognized as a possible complication of GERD often not accompanied by classic GERD symptoms. The clinical course of silent or asymptomatic GERD in these patients, as well as the best treatment options, are unknown. Methods: Patients presenting to the Bern University Dental Clinic with advanced dental erosions (Lussi erosion index >1) without symptoms of reflux (less than once per week) and without treatment for GERD were referred for upper GI-endoscopy and 24-hour esophageal impedance pH-metry after exclusion of extrinsic and non-reflux causes of dental erosions. For analysis a pH-threshold of 4 was applied. All patients with abnormal reflux were treated with esomeprazole 40mg daily (20mg bid). Follow-up impedance pH-metry was performed annually 2 weeks after discontinuation of esomeprazole. Results: 231 successive patients (146 males, mean age and range: 34 (9-67yr) were studied. 214 patients (138 males) had increased reflux (pH 4% of the 24h measurement), with a mean time with pH<4 (95% CI) of 14% (10-18). 54 patients (25%) had esophagitis and 52 (24%) had a hiatal hernia. Follow-up pH-monitoring was possible in 88 patients for up to a mean of 3±1.8 years. The % time with pH<4 during the last 24h pH-monitoring period was 11% (8-14). Reflux had returned to normal levels in 29 patients (33%). During esomeprazole treatment further visual progression of dental erosions only occurred in 12 patients (14%). Summary and Conclusions: In patients presenting to a dental clinic with advanced dental erosions significant, silent GERD is common after exclusion of other possible causes. In most patients treated with esomeprazole 40mg daily there is no further progression of dental erosions. A spontaneous regression of reflux to normal values only occurs in a minority of patients after a mean of 3 years, necessitating long-term preventive treatment.