Chemical clearance of the esophagus associated with neutralization of acid bicarbonates present in saliva and esophageal secretions. Earlier studies have found a statistically significant decrease in ionized calcium in the saliva of patients with gastroesophageal reflux disease (GERD) compared with healthy individuals, and the sensitivity of this technique has made 88,7% and specificity – 72,7%. Study of changes in the concentration of calcium in saliva depending on the form (erosive/non-erosive) GERD is an actual, allowing a differentiated approach to the treatment of these patients.

The aim of the study was to examine the possibility of differentiating form (erosive, non-erosive) of GERD by measuring content of calcium in saliva.

Materials and Methods: saliva samples of 18 patients with GERD were analyzed. The unstimulated saliva was collected 30 minutes after brushing and thorough rinsing of the mouth with distilled water. Calcium content was measured in saliva using calciumsensitive dye Arsenazo III. The study did not include patients with diseases of the oral cavity, which could affect the performance of calcium saliva. A normal value of calcium levels in human saliva was installed on 22 healthy volunteers. All patients underwent questioning and endoscopic examination of the upper gastrointestinal tract.

Results and discussion: Endoscopically in patients with GERD non-erosive 55% was found expressed duodenogastric reflux. Among patients with erosive GERD form 86% had esophagitis stage A, 14% – esophagitis stage B, marked duodenogastric reflux detected in 43% of patients. Analyze of the average levels of ionized calcium in the saliva in test groups revealed that the ranked average number in the group with non-erosive GERD was 0,43 mmol/L (95% CI, 0,32 mmol/L to 0,84 mmol/l) in the group with erosive GERD was 0,28 mmol/l (95% CI 0,21 mmol/l to 0,53 mmol/l) and in the group of volunteers was 1.03 mmol/l (95% CI 0,87 mmol/l to 1,23 mmol/l). Thus, a substantial ionized calcium levels reduction in saliva in patients with GERD were found. We constructed ROC curve for non-erosive GERD groups and for control group, this allowed to highlight the “cut-off point” on the value of saliva ionized calcium 0,73 mmol/l. With such a “cut-off point” sensitivity of the test was 81,8% and specificity was 86,4%. Similarly the analysis was conducted for groups with non-erosive/erosive GERD, which allow to distinguish “distribution point” for them at the level of ionized calcium saliva 0,36 mmol/l. Test sensitivity was 85,7% at such a “cut-off point” and specificity was 81,8%.

Thus, our results suggest a significant diagnostic value of the determination of ionized calcium saliva to determine the form of GERD. With a high degree of confidence when the calcium concentration in the saliva is less than 0,73 mmol/l it is possible to diagnose non-erosive GERD shape, and when the concentration of calcium in the saliva of less than 0,36 mmol/l – erosive GERD.

The introduction of this technique in primary care medical assistance (either alone or in combination with other non-invasive techniques) contributes to the early non-invasive diagnosis non-erosive / erosive form of gastroesophageal reflux disease.

Ключові слова: gastroesophageal reflux disease, calcium saliva, erosive/non-erosive form

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