Medical Emergencies · patient case question
GERD results from dysfunction of which structure?
Patient case: Medically complex patient presenting with erosion and lethargy
Patient: Male, 58 years old
Chief Complaint: Sensitive upper front teeth and a persistent sour taste.
Background: Type 2 diabetes. Long-standing reflux symptoms, worse at night. Recently referred to a nephrologist.
Current Findings: Cupped, smooth erosive lesions on the palatal surfaces of the maxillary anterior teeth. He appears lethargic, describes low mood and slowed thinking, and has a fine white crystalline deposit visible on the skin of his face, trunk and limbs.
Laboratory: HbA1c 8.2%
Show answer and explanation
Correct answer: B. The lower oesophageal sphincter
- A. Upper oesophageal sphincter dysfunction produces oropharyngeal dysphagia — difficulty initiating a swallow, coughing, nasal regurgitation — not acid reflux disease.
- B. CORRECT. The lower oesophageal sphincter normally maintains tone that prevents gastric contents entering the oesophagus. When it is weak or relaxes inappropriately, acid refluxes upward. The dental consequence is a characteristic PALATAL erosion pattern on the maxillary anterior teeth — the surfaces the refluxate reaches first.
- C. The ileocaecal valve separates small from large bowel and has no role in reflux.
- D. The pyloric sphincter guards the gastric outlet into the duodenum. Its dysfunction causes gastric outlet obstruction or dumping, not reflux.
Note: Erosion pattern reads the aetiology: PALATAL maxillary anterior erosion points to intrinsic acid (reflux, vomiting, eating disorder); FACIAL/labial erosion points to extrinsic acid (citrus, carbonated drinks, wine, swimming pools).
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