The aim of this study was to determine the prevalence of dental erosion in young Icelandic adults (19-22 years old) and patients with gastroesophageal reflux disease (GERD), in relation to their soft drink consumption and gastroesophageal reflux. Eighty subjects (40 males and 40 females), comprising 57 young adults (mean age 21 +/- 2 years) and 23 GERD patients (mean age 35 +/- 10 years), were enrolled in this study. All subjects answered a detailed frequency questionnaire of soft drink consumption and participated in a clinical examination. Erosion was scored for incisor and molar teeth separately. No significant difference was observed in the prevalence of dental erosion between young adults and GERD patients. However, by combining the two study groups a three-fold higher risk of having erosion in molars or incisors was found for subjects drinking Coca-Cola three times a week or more often ( p < 0.05). Additionally, significantly higher erosion scores were found in molars among subjects drinking more than 1 litre of carbonated drinks (all brands) per week ( p < 0.05). It is concluded that the frequency of soft drink consumption is a strong risk factor in the development of dental erosion.

Dental erosion is caused by dietary or gastric acid. This study aimed to examine the location and severity of tooth erosion with respect to causative factors, and to determine whether the clinical pattern of erosion reflected the dominant etiological factor. The study involved 249 Icelandic individuals and included: a detailed medical history; clinical oral examination; salivary sampling, and analysis for flow rate, pH, and buffering capacity. Reflux was assessed in 91 individuals by gastroscopy, esophageal manometry, and 24-hour esophageal-pH monitoring. Reflux symptoms were reported by 36.5% individuals. Manometry results were abnormal in 8% of study participants, abnormal esophageal pH in 17.7%, and a pathological 24-hour pH recording in 21.3%. 3.6% were positive for Helicobacter pylori. Normal salivary flow was found in 92%, but low salivary buffering (10.4%) was associated with erosion into dentin (P < 0.05). Significant associations were found between erosion and diagnosed reflux disease (OR 2.772; P < 0.005) and daily consumption of acidic drinks (OR 2.232; P < 0.005).

Two hundred and twenty patients with symptoms suggestive of pathologic gastroesophageal reflux were investigated to elucidate the ability of symptoms and endoscopic findings in establishing a diagnosis of reflux disease as measured by ambulatory 24-h pH-monitoring. Daily occurrence of heartburn or acid regurgitation had positive predictive values of 59% and 66%, respectively. pH-monitoring showed pathologic reflux in 75% of patients with esophageal mucosal erosions. Endoscopic erythema of the distal esophagus predicted reflux disease in only 53%. Symptom registration during ambulatory 24-h pH-monitoring showed that about half of the symptomatic events reported by patients with pathologic reflux occurred within 5 min of a reflux episode. The corresponding figure for patients with normal pH-monitoring was less than 20%. We conclude that it is difficult to establish a diagnosis of gastroesophageal reflux disease by patient history alone, that erythema at endoscopy correlates poorly with pathologic reflux, and that reflux disease may be present even with normal endoscopy findings.

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The variations in gastroesophageal reflux over 24 h were analyzed in 220 patients with symptoms suggestive of gastroesophageal reflux disease and in 50 normal subjects by studying the results obtained by ambulatory 24-h esophageal pH-monitoring. Three time periods, differing in amount of reflux, were identified: daytime (0700-1700 h), evening (1700-2400 h), and night (2400-0700 h). The greatest amount of reflux was seen during the evening period. This pattern was not solely due to increase in reflux postprandially, since it persisted even after the elimination of postprandial reflux. The pattern was most pronounced in patients with esophagitis. The pressure of the distal esophageal high-pressure zone was measured at 0800 h, at noon, and at 1600 h during one day in another 10 patients. The pressure was significantly lower at 1600 h than at 0800 h and at noon, providing a possible explanation for the changes seen in gastroesophageal reflux. We have described a time pattern of gastroesophageal reflux that has important implications for the design of medical therapy in different groups of patients.

TP can safely be done under fluoroscopy and pressure monitoring without routine use of additional techniques. With experience, operators should be able to further decrease complication rate.

Background: Decompensation is frequent in heart failure (HF) patients and predicts poor prognosis. Hypothesis: Volume-overload events in HF patients are preceded by changes in intrathoracic impedance (Z) and body weight (BW); monitoring these parameters may be useful to predict decompensation. Methods: Forty-three HF patients (LVEF 25% ± 12%) with a recent HF event and an implantable cardioverterdefibrillator providing daily Z were equipped with telemonitoring scales submitting daily BW. Changes in BW and Z 30 days prior to major (HF hospitalization) and minor (ambulatory adjustment of diuretics) were analyzed. Results: During median of 427 days follow-up 25 major and 41 minor events occurred. Z decreased by −4.8 (95% confidence interval [CI]: CI −6.7 to −3.0) and −4.3 (95% CI: −5.5 to −3.2) within 30 days prior to major and minor events respectively (P < 0.001). BW increased before major events by 2.3 kg (95% CI: 1.0 to 3.5, P < 0.01) and minor events 1 kg (95% CI: 0.5 to 1.4, P < 0.001). Sensitivity of Z for major/minor HF events was 83.3% (95% CI: 71.7 to 91.0) and for BW 43.9% (95% CI: 31.9 to 56.7). The unexplained detection rate per patient-year was 1.6 (interquartile range [IQR], 0-3.1) for Z and 4.8 (IQR 1.6-11.1) for BW. Combined Z and BW sensitivity was 42.4% (95% CI: 30.6 to 55.2) and unexplained detection rate was 0.8 (IQR, 0-1.5) per patient-year. Conclusions: Decompensation is marked by a decrease in Z and increase in BW the preceding 30 days. Monitoring of Z predicts HF decompensations with better sensitivity and lower unexplained detection rate than BW.