Læknablaðið : fylgirit - 01.06.2005, Blaðsíða 13

ABSTRACTS / XXIX CONGRESS OF THE NORDIC ASSOCIATION OF OTOLARYNGOLOGY
Tooth erosion is a multifactorial disease affecting anterior and
posterior teeth but the known aetiological and protective factors
interact in a complex manner, not yet fully understood, to produce
the variable distribution and severity of erosion that is seen clini-
cally.
Abstract no.: 007
Tooth erosion and GERD
Guðmundsson KG', Holbrook WP2, Ámadóttir I2, Jensdóttir P2. Theodórs Á1.
‘University Hospital, Reykjavík, Iceland, 2University of Iceland
Tooth erosion, defined as erosion of dental hard tissue by intrisic
or extrinsic acid, mostly affects young males. Population studies
on young Europeans indicate 1-2% prevalence of severe erosion
and upwards of 15% of slight erosion. Results of 24 hour esopha-
geal pH monitoring in erosion patients show that a majority of
patients has acid esophageal reflux within normal limits.
Sixtythree erosion patients, mean age 27 years, 50 males and
13 females, underwent 24 hour acid reflux monitoring. Only 25
(40%) had pathological acid reflux, defined as >3.4% of time with
abnormal esophageal acid exposure.
Another group og 23 patients with pathological acid reflux
was investigatied for tooth erosion. Some erosion was found in
34,8% but that does not differ from erosion findings in a group of
57 students screened for erosion, neither in grade nor localization
of erosion.
Abstract no.: 008
24 hour pH monitoring or impedance in evaluating Laryngo-
Pharyngeal Reflux
Kjartan Örvar, Staff Gastroenterologist, St. Joseph's Hospital, Hafnarfirði,
Iceland
Extraesophageal symptoms of gastroesophageal reflux (GER)
have recived much attention lately. Various ear-, nose- and
throat symptoms have been connected with GER and refluxed
acid suggested as the causative agent. The clinical approach to
these patients has been the same as for the patient with ‘classi-
cal acid reflux1 with definite esophageal symptoms. The current
‘gold standard' is still the ambulatory pH-metry where changes
in acid content in the esophageal lumen are used to predict asso-
ciation with upper airways symptoms. However there are many
problems with this approach and larygopharyngeal reflux (LER)
may have somewhat different pathophysiology than GER. The
possible role of non-acid reflux has been suggested as a causative
factor in LER.
The multichannel intraluminal impedance (MII) is a new
evolving technique for evaluating esophageal function where
changes in resistance to alternating current between two metal
electrodes can allow detection of bolus movement and intralumi-
nal pressure. A combined pH- metry with MII will allow assess-
ment of the acidity of the refluxed content and therefore both acid
and non-acid reflux can be detected by this method.
A review of the current litterature on diagnosis of LER will be
given in this lecture.
Abstract no.: 009
Does reflux cause apnea or vice versa?
Berg S, MD PhD, Dept. of ENT, University of Lund, Sweden
An accumulating body of research suggest a causal relationship
between OSA and GER.
The predominating theory is that the transdiaphragmatic pres-
sure increases in parallel with the growing intrathoracic pressure
generated during obstructive apnea episodes leading to reflux.
However, in a smaller number of studies even an inverse
relationship is indicated, suggesting that gastroesophageal reflux
(GER)-initiated laryngeal chemoreflexes contribute to obstruc-
tive sleep apnea (OSA).
Abstract no.: 010
LPR Is Different from Classic GERD
Jamie Koufman, MD, FACS, Director, Center for Voice and Swallowing
Disorders of Wake Forest University and Professor of Surgery
(Otolaryngology), Wake Forest University Health Sciences, Medical
Center Boulevard, Winston-Salem, NC 27157-1034, Tel (336) 716-3876 or
716-8877, jkoufinan@wfubmc.edu www.thevoicecenter.com
LPR patients have head and neck symptoms but uncommonly
have heartburn. Thus, LPR is often called ‘silent reflux.’ LPR
patients are predominantly upright (daytime) refluxers with nor-
mal esophageal motility, and most do not have esophagitis, the
diagnostic sine qua non of GERD. In a prospective study of 58
consecutive patients with pH-documented LPR who underwent
transnasal esophagoscopy, only 12% had esophagitis and another
7% had Barrett’s esophagus; the rest had normal esophagi.
The patterns, mechanisms, manifestations and treatment of
LPR and GERD all differ significantly, and the gastroenterology
model of reflux disease (GERD) does not apply to LPR. The
table below summarizes the typical clinical differences between
LPR and GERD. In addition, the upper airway epithelium is far
more susceptible to reflux-related tissue injury than esophageal
epithelium, and this variable may in large measure account for the
fact that LPR and GERD are clinically so different.
Table I. Summary ofthe Typical Clinical Differences Between GERD and LPR
Symptoms GERD LPR
Heartburn and/or regurgitation ++++ +
Hoarseness, cough, dysphagia, globus Findings + ++++
Esophagitis ++++ +
Laryngeal inflammation Test Results + ++++
Erosive esophagitis or Barrett’s +++ +
Abnormal esophageal pH monitoring ++++ ++
Abnormal pharyngeal pH monitoring + ++++
Esophageal dysmotility +++ +
Abnormal esophageal acid clearance Pattern of Reflux ++++ +
Supine (nocturnal) reflux ++++ +
Upright (daytime ) reflux + ++++
Both (Abnormal upright and supine reflux) + +++
Læknablaðið/Fylgirit 51 2005/91 13