Evidence-based clinical practice guidelines for gastroesophageal reflux disease 2021.

In Japan, with the increasing prevalence of gastroesophageal reflux disease (GERD) and growing public interest, the Japanese Society of Gastroenterology issued Evidence-based Clinical Practice Guidelines for GERD (1st edition) in 2009 and a revised 2nd edition in 2015. A number of studies on GERD were subsequently conducted in Japan and abroad, and vonoprazan, a potassium-competitive acid blocker (P-CAB), became available for the first time in Japan in February 2015. The revised 3rd edition (Japanese edition), which incorporates new findings and information, was published in April 2021. These guidelines are summarized herein, particularly sections related to the treatment of GERD. The important clinical issues addressed in the present revision are (i) the introduction of treatment algorithms that classify GERD into reflux esophagitis and non-erosive reflux disease, (ii) the clarification of treatment algorithms based on to the severity of reflux esophagitis, and (iii) the positioning of vonoprazan in the treatment for GERD. The present guidelines propose vonoprazan as the initial/maintenance treatment for severe reflux esophagitis. They also recommend vonoprazan or PPI as an initial treatment for mild reflux esophagitis and recommended PPI and proposed vonoprazan as maintenance treatment. These updated guidelines offer the best clinical strategies for GERD patients in Japan and hope that they will be of global use for the diagnosis and treatment for GERD.

Development and evaluation of a low-erosive apple juice drink with Phosphoryl-Oligosaccharides of Calcium.

This study aimed to evaluate effectiveness of Phosphoryl-Oligosaccharides of Calcium (POs-Ca) added to apple juice on enamel erosion. Five juices were prepared by adding 0%, 0.5%, 1%, 1.5% or 2% POs-Ca to commercial apple juice, and subjected to Visual Analogue Scale (VAS) taste evaluation and pH and calcium/inorganic-phosphates analyses. To evaluate erosion, polished bovine enamel blocks were immersed in each juice for 5 or 60 min (n=20). Enamel surface loss (SL) and roughness (Ra) were also analyzed. VAS indicated acceptable taste for juices containing up to 1% POs-Ca. POs-Ca addition resulted in increased pH (3.61-3.88), calcium (0.95-25.10 mM), and inorganic-phosphate (1.77-20.44 mM). After 5 min, 0% juice resulted in significant erosion (p<0.05). However even after 60 min, no significant increase was found in Ra and SL compared to water (control) for 1.5-2% juices (p>0.05). Addition of 1-1.5% POs-Ca could significantly reduce enamel erosion by apple juice maintaining an acceptable taste.

Roughness and pH changes of enamel surface induced by soft drinks in vitro-applications of stylus profilometry, focus variation 3D scanning microscopy and micro pH sensor.

This study aimed to evaluate enamel surface roughness (Ra) and pH before and after erosion by soft drinks. Enamel was exposed to a soft drink (cola, orange juice or green tea) for 1, 5 or 60 min; Ra was measured using contact-stylus surface profilometry (SSP) and non-contact focus variation 3D microscope (FVM). Surface pH was measured using a micro pH sensor. Data were analyzed at significance level of alpha=0.05. There was a significant correlation in Ra between SSP and FVM. FVM images showed no changes in the surface morphology after various periods of exposure to green tea. Unlike cola and orange juice, exposure to green tea did not significantly affect Ra or pH. A significant correlation was observed between surface pH and Ra change after exposure to the drinks. Optical surface analysis and micro pH sensor may be useful tools for non-damaging, quantitative assessment of soft drinks erosion on enamel.

Physiological remineralization of artificially demineralized dentin beneath glass ionomer cements with and without bacterial contamination in vivo.

This study evaluated the physiological remineralization of artificially demineralized dentin beneath glass ionomer cements with and without bacterial contamination. The artificially demineralized dentin was produced on 84 monkey teeth using a decalcifying solution. Half the samples were left open to the oral cavity for one week, then, all cavities were restored with two glass-ionomer cements: Fuji IX or Fuji II LC improved (n = 7). The nanohardness of the artificially demineralized dentin at 3, 90 and 360 days was measured using a nanoindentation tester (ENT-1100, Elionix) and compared statistically by two-way ANOVA and Fisher's PLSD test (p < 0.05). Each mineral (Ca, Mg, P, F) within the demineralized dentin was also analyzed using Electron Probe Microanalysis. For the samples, the mean nanohardness of the three-day samples was significantly lower than the 360-day samples (p < 0.05). Although there was no significant difference in the mean nanohardness within all the bacterially-contaminated groups through the experimental periods (p > 0.05), the mean nanohardness of the bacterial-contaminated samples were significantly lower than the non-bacteria-contaminated samples (p < 0.05). From the EPMA results, fluoride release from both cements to the bottom of the artificially demineralized dentin was detected within three days. Although Ca density was sparse within this demineralized dentin lesion, for the Fuji IX sample, a high Mg density within this lesion was detected at 360 days.