The Association between Gastrooesophageal Reflux Disease and Subsequent Rheumatoid Arthritis Occurrence

Background and Aims: Rheumatologic disorders (RDs) can manifest as gastrointestinal (GI) symptoms. Patients with systemic sclerosis (SSc) frequently experience upper GI symptoms due to a lack of esophageal contractility (AC). GORD (gastro oesophageal reflux disease) is a common comorbidity in rheumatoid arthritis patients (RA).The aim of the present study was to evaluate the correlation between manifestation of rheumatoid arthritis and gastrooesophageal reflux disease. Materials and Methods: This cross-sectional study was carried out on 845 gastro-oesophageal reflux disease patients who presented to department of medicine, Qazi Hussain Ahmad Medical Complex Nowshera and Lady Reading Hospital (LRH), Peshawar for period of six months i.e from January 2020 to June 2020. Consecutive patients with were premeditated subsequently taking written informed consent. Patients with prior history of Oesophageal surgery were excluded. The demographics characteristics such as age, BMI, gender, previous history, gastrointestinal symptoms severity, analgesics, and medication usage were recorded on a pre-designed questionnaire. Inflammatory marker’s results were taken in the forms of C - reactive protein (CRP), and Erythrocyte Sedimentation Rate (ESR). Ethical approval was taken from the respective institutional review board. SPSS version 20 was used for data analysis. Results: Out of 845 GORD patients, 110 (13%) had Rheumatologic disorders (mean age 49.5± 2.6 years, 71% females). The prevalence of rheumatoid arthritis (RA), systemic lupus erythematous (SLE), and the most common systemic sclerosis (SSc) were 39 (36%), 24 (21.8%), and 47 (42.2%) respectively. Regurgitation, dysphagia, heartburn, and nausea were the most severe symptoms of gastrointestinal patients having rheumatoid disorder. The GI symptoms had no significant association with SLE, RA, and SSc severity. Upper GI symptom severity did not differentiate between RDs. Conclusion: Our study concluded that subsequent rheumatoid arthritis has a significant association with gastro-oesophageal reflux disease. Keywords: Gastro-oesophagealReflux Disease, Rheumatoid arthritis, Systemic sclerosis

Conservative Management of Dental Erosion in Adolescents with Medical Conditions

The prevalence of dental erosion among children and adolescents is trending higher in recent decades and is becoming a major concern. Dental erosion can be caused by either extrinsic or intrinsic acids or both. One of the established aetiological factors for dental erosion by intrinsic acid is the gastrooesophageal reflux disease. The degree of dental erosions may be influenced by any medical conditions that cause a reduction in salivary flow such as the salivary gland excision, autoimmune disease, radiation to the head and neck regions, and medications. If left untreated, the dental erosion can cause dentine hypersensitivity, loss of occlusal vertical height, and aesthetic problems. For effective management of dental erosion, the aetiology of each case must be determined, and its detection at an early stage is of prime importance. This case report illustrates the conservative management of dental erosion in two adolescent patients presented with their medical conditions and behaviour issues. The aim of the treatments was to preserve the vitality of the affected teeth. The treatments were successfully completed using a conservative approach, with the patients’ medical conditions taken into consideration.