Alimentary tract| Volume 54, ISSUE 3, P331-335, March 2022

Reduced masticatory function predicts gastroesophageal reflux disease and esophageal dysphagia in patients referred for upper endoscopy: A cross-sectional study

Published:October 11, 2021DOI:



      The role of mastication on gastroesophageal reflux disease (GERD) is unknown.


      To assess whether reduced masticatory function predicts GERD and esophageal dysphagia in patients investigated with upper endoscopy.


      In this cross-sectional study, 179 adult patients referred for elective upper gastrointestinal endoscopy agreed to participate. Before endoscopy, an expert dentist performed an oral examination and scored chewing function in three levels (normal, regular, and reduced). Patients replied questionnaires for assessment of GERD (heartburn, regurgitation, and dysphagia), xerostomia, and mastication (normal, regular, and reduced). Poor chewing was defined when either oral examination or mastication questionnaire rated the chewing function as reduced. Associations of mastication with GERD and dysphagia were estimated using Poisson regression.


      Eleven patients were excluded. Among 168 analyzed (aging 49.8 ± 15.5 years; 58.9% women), 46 had reduced masticatory function (27.4%), and 122 had regular/normal mastication (72.6%). Reduced mastication was associated with GERD [PR = 1.38 (95%CI 1.12 – 1.70)], adjusting for age, and with esophageal dysphagia [PR = 2.03 (95%CI 1.02 – 4.04)], adjusting for age and xerostomia.


      In outpatients referred for upper gastrointestinal endoscopy, reduced masticatory function defined by an expert dentist may be a risk factor for GERD and esophageal dysphagia.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Digestive and Liver Disease
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Eusebi L.H.
        • Ratnakumaran R.
        • Yuan Y.
        • et al.
        Global prevalence of, and risk factors for, gastro-oesophageal reflux symptoms: a meta-analysis.
        Gut. 2018; 67: 430-440
        • Katzka D.A.
        • Pandolfino J.E.
        • Kahrilas P.J.
        Phenotypes of gastroesophageal reflux disease: where Rome, Lyon, and Montreal meet.
        Clin Gastroenterol Hepatol. 2020; 18: 767-776
        • Maret-Ouda J.
        • Markar S.R.
        • Lagergren J.
        Gastroesophageal reflux disease: a review.
        JAMA. 2020; 324: 2536-2547
        • Vaezi M.F.
        • Katzka D.
        • Zerbib F.
        Extraesophageal symptoms and diseases attributed to GERD: where is the pendulum swinging now?.
        Clin Gastroenterol Hepatol. 2018; 16: 1018-1029
        • Gyawali C.P.
        • Kahrilas P.J.
        • Savarino E.
        • et al.
        Modern diagnosis of GERD: the Lyon consensus.
        Gut. 2018; 67: 1351-1362
        • Ang D.
        • Lee Y.Y.
        • Clarke J.O.
        • et al.
        Diagnosis of gastroesophageal reflux: an update on current and emerging modalities.
        Ann N Y Acad Sci. 2020; 1481: 154-169
        • Fass R.
        • Zerbib F.
        • Gyawali C.P.
        AGA clinical practice update on functional heartburn: expert review.
        Gastroenterology. 2020; 158: 2286-2293
        • Tack J.
        • Pandolfino J.E.
        Pathophysiology of gastroesophageal reflux disease.
        Gastroenterology. 2018; 154: 277-288
        • Helm J.F.
        • Dodds W.J.
        • Pelc L.R.
        • et al.
        Effect of esophageal emptying and saliva on clearance of acid from the esophagus.
        N Engl J Med. 1984; 310: 284-288
        • Baumgarten A.
        • Schmidt J.G.
        • Rech R.S.
        • et al.
        Dental status, oral prosthesis and chewing ability in an adult and elderly population in southern Brazil.
        Clinics (Sao Paulo). 2017; 72: 681-685
        • Di Stefano M.
        • Carnevale Maffè G.
        • Mazzocchi S.
        • et al.
        The role of masticatory alterations in the pathophysiology of dyspeptic symptoms: a study on healthy volunteers.
        Digest Liver Dis. 2009; 41: S140
        • von Elm E.
        • Altman D.G.
        • Egger M.
        • et al.
        The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies.
        J Clin Epidemiol. 2008; 61: 344-349
        • Hilasaca-Mamani M.
        • Barbosa Tde S.
        • Fegadolli C.
        • et al.
        Validity and reliability of the quality of masticatory function questionnaire applied in Brazilian adolescents.
        Codas. 2016; 28: 149-154
        • da Mata A.D.
        • da Silva Marques D.N.
        • Freitas F.M.
        • et al.
        Translation, validation, and construct reliability of a Portuguese version of the Xerostomia Inventory.
        Oral Dis. 2012; 18: 293-298
        • Fornari F.
        • Gruber A.C.
        • Lopes Ade B.
        • et al.
        [Symptom's questionnaire for gastroesophageal reflux disease].
        Arq Gastroenterol. 2004; 41: 263-267
        • Textor J.
        • van der Zander B.
        • Gilthorpe M.S.
        • et al.
        Robust causal inference using directed acyclic graphs: the R package 'dagitty'.
        Int J Epidemiol. 2016; 45: 1887-1894
        • van der Bilt A.
        • Engelen L.
        • Pereira L.J.
        • et al.
        Oral physiology and mastication.
        Physiol Behav. 2006; 89: 22-27
        • Korsten M.A.
        • Rosman A.S.
        • Fishbein S.
        • et al.
        Chronic xerostomia increases esophageal acid exposure and is associated with esophageal injury.
        Am J Med. 1991; 90: 701-706
        • Frazzoni M.
        • Bertani H.
        • Manta R.
        • et al.
        Impairment of chemical clearance is relevant to the pathogenesis of refractory reflux oesophagitis.
        Dig Liver Dis. 2014; 46: 596-602
        • Milani D.C.
        • Venturini A.P.
        • Callegari-Jacques S.M.
        • et al.
        Gastro-oesophageal reflux disease and dental erosions in adults: influence of acidified food intake and impact on quality of life.
        Eur J Gastroenterol Hepatol. 2016; 28: 797-801
        • Correa M.C.
        • Lerco M.M.
        • Cunha Mde L.
        • et al.
        Salivary parameters and teeth erosions in patients with gastroesophageal reflux disease.
        Arq Gastroenterol. 2012; 49: 214-218
        • Bourdiol P.
        • Hennequin M.
        • Peyron M.A.
        • et al.
        Masticatory adaptation to occlusal changes.
        Front Physiol. 2020; 11: 263
        • Boven G.C.
        • Raghoebar G.M.
        • Vissink A.
        • et al.
        Improving masticatory performance, bite force, nutritional state and patient's satisfaction with implant overdentures: a systematic review of the literature.
        J Oral Rehabil. 2015; 42: 220-233
        • Ness-Jensen E.
        • Lagergren J.
        Tobacco smoking, alcohol consumption and gastro-oesophageal reflux disease.
        Best Pract Res Clin Gastroenterol. 2017; 31: 501-508
        • Pedersen A.
        • Sorensen C.E.
        • Proctor G.B.
        • et al.
        Salivary functions in mastication, taste and textural perception, swallowing and initial digestion.
        Oral Dis. 2018; 24: 1399-1416
        • Richter J.E.
        • Rubenstein J.H.
        Presentation and epidemiology of gastroesophageal reflux disease.
        Gastroenterology. 2018; 154: 267-276
        • Pesce P.
        • Menini M.
        • Furnari M.
        • et al.
        Gastric and masticatory performances in full-arch immediate loading rehabilitated patients.
        J Oral Rehabil. 2015; 42: 663-669
        • Suzuki J.
        • Shimazaki K.
        • Koike S.
        • et al.
        Gastric emptying rate before and after orthodontic treatment examined with the [(13)C] breath test: a pilot study.
        Am J Orthod Dentofacial Orthop. 2018; 153: 347-354
        • Emerenziani S.
        • Sifrim D.
        Gastroesophageal reflux and gastric emptying, revisited.
        Curr Gastroenterol Rep. 2005; 7: 190-195
        • Frazzoni M.
        • Frazzoni L.
        • Ribolsi M.
        • et al.
        Esophageal pH increments associated with post-reflux swallow-induced peristaltic waves show the occurrence and relevance of esophago-salivary reflex in clinical setting.
        Neurogastroenterol Motil. 2021; 33: e14085
        • Ribolsi M.
        • Frazzoni M.
        • De Bortoli N.
        • et al.
        Reflux characteristics triggering post-reflux swallow-induced peristaltic wave (PSPW) in patients with GERD symptoms.
        Neurogastroenterol Motil. 2021; : e14183
        • Frazzoni M.
        • Frazzoni L.
        • De Bortoli N.
        • et al.
        Response of eosinophilic oesophagitis to proton pump inhibitors is associated with impedance-pH parameters implying anti-reflux mechanism of action.
        Aliment Pharmacol Ther. 2021; 53: 1183-1189
        • Frazzoni M.
        • Penagini R.
        • Frazzoni L.
        • et al.
        Role of reflux in the pathogenesis of eosinophilic esophagitis: comprehensive appraisal with off- and on PPI impedance-pH monitoring.
        Am J Gastroenterol. 2019; 114: 1606-1613
        • Johnston B.T.
        Oesophageal dysphagia: a stepwise approach to diagnosis and management.
        Lancet Gastroenterol Hepatol. 2017; 2: 604-609
        • Campisi G.
        • Lo Russo L.
        • Di Liberto C.
        • et al.
        Saliva variations in gastro-oesophageal reflux disease.
        J Dent. 2008; 36: 268-271
        • Taft T.H.
        • Riehl M.
        • Sodikoff J.B.
        • et al.
        Development and validation of the brief esophageal dysphagia questionnaire.
        Neurogastroenterol Motil. 2016; 28: 1854-1860
        • Peyron M.A.
        • Woda A.
        • Bourdiol P.
        • et al.
        Age-related changes in mastication.
        J Oral Rehabil. 2017; 44: 299-312
        • Frazzoni L.
        • Frazzoni M.
        • De Bortoli N.
        • et al.
        Application of lyon consensus criteria for GORD diagnosis: evaluation of conventional and new impedance-pH parameters.
        Gut. 2021;
        • Ribolsi M.
        • Frazzoni M.
        • Marabotto E.
        • et al.
        Novel impedance-pH parameters are associated with proton pump inhibitor response in patients with inconclusive diagnosis of gastro-oesophageal reflux disease according to Lyon Consensus.
        Aliment Pharmacol Ther. 2021; 54: 412-418