Burning mouth syndrome and Reflux Disease: relationship and clinical implications

Background and aim: An association between reflux and burning mouth syndrome (BMS) has been proposed for a long time, although there is little evidence of a connection. Aims of this study were threefold: 1) to investigate the frequency of BMS in a sample of GERD patients showing both typical and atypical symptoms; 2) to measure a non-invasive marker of GERD, i.e. serum Gastrin 17, in a sample of BMS patients; 3) to assess the efficacy of different therapeutical schedules for GERD in BMS patients. Methods: We divided the study in 3 main steps. In step one, we selected 500 consecutive GERD patients to analyze type and frequency of extraesophageal manifestations of reflux disease, including BMS. In step two, we selected 124 consecutive BMS patients and collected data about symptoms presentation and serum gastrin 17 levels. In step three, we performed a follow-up evaluating the efficacy of 3 different drugs on BMS. Results: In step one, 204 patients complained heartburn; 31 pharyngeal globus; 52 chronic cough; 54 pharyngitis; 31 postnasal drip; 56 burning mouth symptoms; 34 noncardiac chest pain; 17 asthma and 21 sleep apnea. In step two, 29 patients had gastrin-17 ≤ 1 pg/L; 64 patients between 1 and 3; and 31 patients ≥ 3. In step three, 49 patients reported slight benefit with PPI, 75 no benefit. 61 patients reported slight benefit with sodium alginate and sodium bi-carbonate, 63 no benefit. 23 reported an almost complete remission with HYCHSA, 26 slight benefits, 33 no benefit. Conclusions: Prevalence of BMS in GERD patients was similar to that reported for chronic chough and pharyngitis. Low levels of Gastrin 17 were found in the majority of BMS patients. Finally, we observed a greater benefit from barrier drugs therapy than from PPI therapy in BMS patients. (www.actabiomedica.it).