title: Acid Rather Than Nonacid Reflux Burden Is a Predictor of Tooth Erosion.
abstract: OBJECTIVE
  The relation between tooth erosion (TE) and gastroesophageal reflux in children has not been clearly established, and there are no studies to determine the relation with refluxate height, nonacid reflux, and erosions. The aim of this study was to determine the relation between TE and acid and nonacid gastroesophageal refluxes measured using combined pH and multichannel intraluminal impedance (pH-MII).
  
  
  METHODS
  We conducted a prospective cohort study of children presenting for pH-MII testing. Once informed consent was obtained, patients completed questionnaires about their reflux symptoms and diet, and then underwent pH-MII catheter placement and a dental examination. The Keels-Coffield erosion index was used to score the extent and severity of TE. Reflux parameters of patients with and without TE were compared using Student t test and correlations were performed using Spearman correlations.
  
  
  RESULTS
  A total of 27 patients participated in the study, all of whom were on acid suppression at the time of pH-MII testing. Of the 27 patients, 10 (37%) had TE. There were significant positive correlations between acid reflux episodes (r = 0.44, P = 0.02), the percentage of time that acid reflux was present in the distal esophagus (r = 0.44, P = 0.02), and reflux index (r = 0.54, P = 0.004) with the number of TE in a given patient. The percentage of time that acid reflux was present in the proximal esophagus was positively correlated with the number of teeth erosions per patient with borderline significance (r = 0.38, P = 0.05).
  
  
  CONCLUSIONS
  There was a positive correlation between acid reflux parameters and TE. Acid, rather than nonacid reflux, seems to have a significant role in the pathogenesis of TE.
authors.affiliation: *Department of Pediatric Gastroenterology †Department of Dentistry, Boston Children's Hospital, Boston, MA.
authors.forename: Meenakshi
authors.initials: M
authors.lastname: Ganesh
authors.forename: Anne
authors.initials: A
authors.lastname: Hertzberg
authors.forename: Samuel
authors.initials: S
authors.lastname: Nurko
authors.forename: Howard
authors.initials: H
authors.lastname: Needleman
authors.forename: Rachel
authors.initials: R
authors.lastname: Rosen
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D017097:Electric Impedance; D050782:Esophageal pH Monitoring; D004947:Esophagus / Q000737:chemistry*; D005260:Female; D005744:Gastric Acid; D005764:Gastroesophageal Reflux / Q000150:complications* / Q000473:pathology; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008297:Male; D011446:Prospective Studies; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D014070:Tooth; D014077:Tooth Erosion / Q000209:etiology*