Спектр стоматологических проявлений гастроэзофагеальной рефлюксной болезни и подходы к их верификации

Гастроэзофагеальная рефлюксная болезнь (ГЭРБ) относится к числу наиболее распространенных заболеваний в терапевтической практике. Нередко у пациентов, помимо классических жалоб, встречаются и внепищеводные симптомы, что может затруднять диагностику ГЭРБ и требует реализации междисциплинарного подхода к курации с привлечением смежных специалистов. К таковым относятся стоматологические проявления ГЭРБ, которые условно можно разделить на поражение мягких тканей ротовой полости (красная кайма губ, слизистая оболочка ротовой полости, язык, ткани пародонта) и твердых тканей зуба (эмаль и дентин). Эпидемиологические данные о распространенности тех или иных стоматологических проявлений ГЭРБ достаточно ограничены и неоднородны. Рассматривается ряд патогенетических факторов, объясняющих причинно-следственную связь поражений ротовой полости и зубов с ГЭРБ, включая прямое повреждающее действие агрессивных молекул рефлюксата, изменение физико-химических свойств слюны в виде снижения ее буферной емкости, уменьшения секреции муцинов, факторов роста и антимикробных пептидов, а также бруксизм. С практической точки зрения установить связь между ГЭРБ и возможными стоматологическими проявлениями достаточно сложно из-за гетерогенности и неспецифичности последних. При подозрении на ГЭРБ у пациентов с поражением ротовой полости и/или зубов целесообразно использование опросника GERDQ, эзофагогастродуоденоскопии, а в ряде случаев – 24или 48-часовой pH-импедансометрии и манометрии высокого разрешения. Потенциальную перспективу в качестве скрининга для выделения когорты лиц, нуждающихся в дальнейшем обследовании, могут представлять тест-системы для определения уровня пепсина и желчных кислот в слюне.

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