-Original-

Dental Erosion in Patients Undergoing Endoscopic Treatment for Esophageal Achalasia: A Cross-Sectional Study of Prevalence, Severity, and Clinical Characteristics

Yuichi Kitasako^1,2, Tomohide Tanabe¹, Mai Koeda¹, Eri Momma¹, Yoshimasa Hoshikawa¹, Shintaro Hoshino¹, Noriyuki Kawami¹, Masaomi Ikeda³, Katsuhiko Iwakiri¹ and Masanori Atsukawa¹

¹Department of Gastroenterology, Nippon Medical School, Graduate School of Medicine, Tokyo, Japan
²Department of Cariology and Operative Dentistry, Graduate School of Medical and Dental Sciences, Institute of Science Tokyo, Tokyo, Japan
³Department of Oral Biomedical Engineering, Graduate School of Medical and Dental Sciences, Institute of Science Tokyo, Tokyo, Japan

Background: Reflux esophagitis is associated with dental erosion (DE). However, the relationship between esophageal achalasia and DE is unclear. Endoscopic treatment is effective for esophageal achalasia and is the standard treatment worldwide. This study evaluated DE prevalence and severity in relation to the clinical characteristics of patients undergoing endoscopic treatment for achalasia.
Methods: This cross-sectional study included 75 patients with achalasia who underwent endoscopic treatment. DE prevalence was evaluated using a modified tooth wear index. The presence of reflux esophagitis after endoscopic treatment was evaluated by using the Los Angeles (LA) classification, which is based on esophagogastroduodenoscopy images. DE prevalence and severity were assessed in relation to clinical characteristics, including proton pump inhibitor (PPI) medication and reflux esophagitis status after endoscopic treatment. Pearson's chi-square test was used to analyze DE prevalence and severity.
Results: Sixteen patients were categorized as having DE (21.3%), and most of these cases were mild. Age, sex, body mass index, the interval between endoscopic treatment and DE evaluation, achalasia type and distribution, endoscopic treatment type, and LA classification of reflux esophagitis did not differ significantly between patients with and without DE. However, PPI response/resistance and continuation/discontinuation significantly differed between patients with and without DE (p < 0.05).
Conclusions: PPI response/resistance and continuation/discontinuation might be associated with DE prevalence in patients with achalasia who underwent endoscopic treatment.
Trial Registration: UMIN000048746

J Nippon Med Sch 2026; 93: 370-376

Keywords
esophageal achalasia, dental erosion, endoscopic treatment, reflux esophagitis, proton pump inhibitor

Correspondence to
Yuichi Kitasako
yuichi-kitasako@nms.ac.jp

Received, April 6, 2026
Accepted, June 8, 2026