Gastroesophageal Reflux Disease (GERD)

1
Gastroesophageal Reflux Disease(GERD)

• Presented by Rachel Lang
• April 15, 2003
• ASC 823 C

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GERD

• Often called reflux
• It is the recurring backflow of acid from the
  stomach into the esophagus

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FACTS

• According to the U.S. Department of Health and
  Human Services
• 7 million Americans suffer from GERD
• The incidence of GERD increases dramatically in
  people over the age of 40

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Why GERD occurs

• The lower esophageal sphincter (LES) is a tight
  muscle at the bottom of the esophagus
• The LES is designed to relax when the food passes
  through the esophagus into the stomach
• Reflux can occur when the tightness of the LES
  decreases

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Causes of Lowered LES Pressure

• High fat and carbohydrates in diet
• Alcohol consumption
• Tobacco products
• Carminatives (peppermint spearmint)
• Acidic fruit juices tomato-based foods
• Some medications (e.g. calcium channel blockers
  nitrates)
• Forceful abdominal breathing

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Diagnostics

• Laryngoscopy
• 24-hour pH monitoring
• Endoscopy

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Symptoms of GERD

• Hoarseness
• Post-nasal drip
• Throat pain
• Persistent cough
• Throat clearing
• Dysphagia
• Globus sensation
• Primary symptom is heart burn

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Functionally Abusive Vocal Behaviors

• Result from behaviors that attempt to compensate
  for hoarseness or irritation
• This increases severity of original problem
  symptoms

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Voice Problems

• Hoarseness
• Increase in muscle tension
• Restricted vocal tone placement
• Hard glottal attack
• Glottal fry
• Vocal process granulomas
• Contact ulcers

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Voice Therapy

• Easy onset
• Throat and neck stretching exercises
• Change throat focus to face
• Vocal hygiene
• Reduce throat clearing

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Behavior Modification

• Elevate the head of the bed 6 to 8 inches
• Take antacids
• Eat smaller meals
• Chew bicarbonate gum
• Chew De-Glycyrrhizinated Licorice (DGL)
• Dont lie down right after meals
• Maintain a healthy weight

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Avoid

• Tobacco
• Foods high in fat
• Spicy food
• Alcohol
• Caffeine Chocolate
• Activities that compress the abdomen

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Pharmacotherapy

• Reduce acidity
• H2 Antagonists
• Over the counter
• Pepcid Zantac
• Proton Pump Inhibitors (PPI)
• Prescription only
• Prilosec, Prevacid, Nexium

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Surgery

• Nissen fundoplication
• Procedure that tightens the LES
• Wraps the upper part of the stomach around the
  esophagus

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Refrences

• Ahuja, V., Lassen, L., Yenchen, M. (1999,
  September). Head and neck manifestations of
  gastroesophageal reflux disease. American Family
  Physician, 60, 873-86.
• Boone, D.R. MacFarlane, S. (2000). The voice
  and voice therapy (6th ed.). Boston Allyn and
  Bacon
• Division of Speech and Hearing Sciences at the
  University of North Carolina. Gastroesophageal
  reflux disease. Retrieved on April 1, 2003, from
  http//www.unc.edu/chooper/classes/voice/webthera
  py/gerd/Voice.html
• Greater Baltimore Medical Center. Reflux changes
  to the larynx.. Retrieved on April 1, 2003, from
  http//www.gbmc.org/voice/refluxchanges.cfm
• Scripps Center for Voice and Swallowing.
  Gastroesophageal reflux disease. Retrived on
  April 1, 2003, from http//scripps.org/print/print
  friendly-article.htm