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Background:Among the extra-esophagealmanifestations of GERD, dental erosion is currently considered one of the most frequent. These dental erosions have a characteristic localization and may sometimes be the first symptom of the GERD. Wireless nasopharyngeal pH metry (ResTech pH probe) is a minimally invasive device for detection of oropharyngeal acid reflux.Aim: To ascertain whether adult patients with dental erosions (DE) have a higher incidence of reflux into the nasopharynx compared with controls using the ResTech phH probe.Materials and methods: A cross-sectional study was conducted among patients whom attend to the dental service at the Health Services Research Center in our institution. Dental erosion was classified by means of severity and anatomic location, according to the Eccles and Jenkins dental (0=no erosion present [control group];grade 1=loss of surface detail, with change confined to the enamel; grade 2=exposure of dentin affecting less than one third of the crown; and 3=exposure of dentin affecting one third or more of the crown). In all subjects eating habits and dental medical history (CPO index) was obtained and GERD symptoms were assessed using the GERD-Q questionnaire and the ISR index. In all subjects a Restech Dx-pH was performed and separate pH thresholds of 0.05). DE subjects had a higher prevalence of positive GERD-Q questionnaires (92% vs 42%, p=0.002) and also higher scores (45 vs 6, p=0.01). DE subjects had more number of reflux episodes at pH 5.0 and 4.5 compared to HC (p

Recent studies have shown that many patients use acid suppression medications after antireflux surgery. The aim of this study was to determine the frequency of gastroesophageal reflux disease in a cohort of surgically treated patients with postoperative symptoms and a high prevalence of acid suppression medication use. The study group consisted of 86 patients who had symptoms following Nissen fundoplication that were sufficient to merit evaluation with 24-hour distal esophageal pH monitoring. All completed a detailed symptom questionnaire. The mean postoperative follow-up period was 28 months (median 18 months). Thirty-seven patients (43%) were taking acid suppression medications after fundoplication. Only 23% (20 of 86) of all the patients and only 24% (9 of 37) of those taking acid suppression medications had abnormal esophageal acid exposure on the 24-hour pH study. Heartburn and regurgitation were the only symptoms that were significantly associated with an abnormal pH study. Endoscopic assessment of the fundoplication was the most significant factor associated with an abnormal pH study. Multivariable logistic regression analysis showed that patients with a disrupted, abnormally positioned fundoplication had a 52.6 times increased risk of abnormal esophageal acid exposure. Most patients who use acid suppression medications after antireflux surgery do not have abnormal esophageal acid exposure, and the use of these medications is thus often inappropriate. Because of the limited predictive power of symptoms, objective evidence of reflux disease should be obtained before prescribing acid suppression medication for patients who have undergone antireflux surgery.

Recent studies have shown that many patients use acid suppression medications after antireflux surgery. The aim of this study was to determine the frequency of gastroesophageal reflux disease in a cohort of surgically treated patients with postoperative symptoms and a high prevalence of acid suppression medication use. The study group consisted of 86 patients who had symptoms following Nissen fundoplication that were sufficient to merit evaluation with 24-hour distal esophageal pH monitoring. All completed a detailed symptom questionnaire. The mean postoperative follow-up period was 28 months (median 18 months). Thirty-seven patients (43%) were taking acid suppression medications after fundoplication. Only 23% (20 of 86) of all the patients and only 24% (9 of 37) of those taking acid suppression medications had abnormal esophageal acid exposure on the 24-hour pH study. Heartburn and regurgitation were the only symptoms that were significantly associated with an abnormal pH study. Endoscopic assessment of the fundoplication was the most significant factor associated with an abnormal pH study. Multivariable logistic regression analysis showed that patients with a disrupted, abnormally positioned fundoplication had a 52.6 times increased risk of abnormal esophageal acid exposure. Most patients who use acid suppression medications after antireflux surgery do not have abnormal esophageal acid exposure, and the use of these medications is thus often inappropriate. Because of the limited predictive power of symptoms, objective evidence of reflux disease should be obtained before prescribing acid suppression medication for patients who have undergone antireflux surgery.

THE CONTRIBUTION OF THE SLING FIBERS TO LOWER ESOPHAGEAL SPHINCTER ASYMMETRY. JH Schneider, PF Crookes, H Thomas, CG Bremner, TR DeMeester. Department of Surgery, University of Southern California, Los Angeles, California. The sling fibers are located on the left lateral quadrant of the cardia. The significance of this muscle layer for normal and pathologic function of the lower esophageal sphincter (LES) is still controversial and the evaluation of it’s pressure contribution to the LES has not previously been possible. A new circular four channel water-perfused sleeve catheter was developed to quantify this pressure. Materials and Method: The basal pressure of the LES (LESP) was detected in 2 groups. 1: controls (n=34), 2: refluxers (n=51). The patients underwent gastroscopy, x-ray examination and 24-hr monitoring before long-term manometry. All subjects were measured with the circular sleeve (size 5Ox4mm) in the supine position. Each channel was perfused with O.Sml/min water. The station pull-through technique (SPT) was used to measure the LESP. The circular sleeve was validated with the Dent sleeve and a conventional four side hole catheter. The left lateral position of channel III, which measured the sling fiber pressure contribution, was confiied radiologically. Pressures were compared during various body position changes in controls. The students T-test and Mann-Whitney-U test were utilized to compare the results (Table). LESP mmHg(xfSW