Risk factors associated with oral manifestations and oral health impact of gastro-oesophageal reflux disease: a multicentre, cross-sectional study in Pakistan

BMJ Open. 2019 Mar 30;9(3):e021458. doi: 10.1136/bmjopen-2017-021458.

Abstract

Objective: Gastro-oesophageal reflux disease (GORD) is a relatively common disorder and manifests with extraoesophageal symptoms, such as dental erosions (DE), cough, laryngitis, asthma, and oral soft- and hard-tissue pathologies. This study aimed (1) to identify oral soft and hard-tissue changes in patients with GORD and (2) to evaluate these oral changes as indices for assessing GORD and its severity.

Setting: This cross-sectional study was conducted at four major tertiary care government hospitals, in two metropolitan cities of Pakistan.

Participants: In total, 187 of 700 patients who underwent oesophago-gastro-duodenoscopy and having GORD were included in the study. Patients with GORD were divided according to the presence of DE into group A (with DE, chronic/severe GORD) and group B (without DE, mild GORD). Patients who were unconscious and had extremely limited mouth opening were excluded.

Primary and secondary outcome measures: Abnormal conditions and lesions of the oral mucosa were recorded. The impact of oral hard and soft-tissue changes on the oral health-related quality of life was assessed using the Pakistani (Urdu) version of the validated Oral Health Impact Profile-14 (OHIP-14) instrument.

Results: Oral submucous fibrosis (66.3%), ulceration (59.4%) and xerostomia (47.6%) were significantly more common in group A (p<0.05). The prevalence of GORD was 26.7%, within which the prevalence of DE was 35.3%. Unhealthy dietary pattern, nausea/vomiting, oesophagitis, xerostomia, ulceration, gingivitis and angular cheilitis showed a statistically significant association with chronic GORD and DE. All subscales of OHIP-14 were positively correlated (p<0.05) in patients with GORD and DE, with notable impact on psychological discomfort (rs=0.30), physical disability (rs=0.29), psychological disability (rs=0.27) and functional limitation (rs=0.20).

Conclusion: Patients with GORD and DE presented with more severe oral manifestations than did those with GORD and no DE. We recommend timely dental check-ups to assess the severity of both systemic and oral disease.

Keywords: GERD; GORD; endoscopy; epidemiology; gastroenterology; oral manifestations; oral medicine; preventive medicine; public health.

Publication types

  • Multicenter Study

MeSH terms

  • Correlation of Data
  • Cross-Sectional Studies
  • Endoscopy, Digestive System / methods
  • Endoscopy, Digestive System / statistics & numerical data
  • Female
  • Gastroesophageal Reflux* / diagnosis
  • Gastroesophageal Reflux* / epidemiology
  • Gastroesophageal Reflux* / physiopathology
  • Humans
  • Male
  • Middle Aged
  • Mouth Diseases* / diagnosis
  • Mouth Diseases* / epidemiology
  • Mouth Diseases* / etiology
  • Mouth Diseases* / psychology
  • Oral Health / statistics & numerical data*
  • Pakistan / epidemiology
  • Quality of Life*
  • Risk Factors
  • Severity of Illness Index
  • Tooth Erosion* / diagnosis
  • Tooth Erosion* / epidemiology
  • Tooth Erosion* / etiology