The Otolaryngologic Manifestation Of GERD

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The Otolaryngologic Manifestation Of GERD

• Dr Khalil Sendi
• MD, FRCSC , FACS
• ENT SURGEON

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The Antireflux BARRIER

• Lower Esophageal Sphincter (LES).
• Esophageal Acid Clearance.
• Epithelial Resistance.
• Upper Esophgeal Sphincter.

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The lower Esophageal Sphincter

• Anatomic Factors
• Diaphragm muscle sling.
• Cardiac angle.
• Intra-abdominal Esophageal segment.
• Phrenoesophageal ligment (H.H).
• Neural Innervation
• Causing relaxation of LES during swallowing.
• Hormonal factors
• Gastrin increase LES pressure.

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Esophageal Acid Clearance

• Peristalisis.
• Saliva Bicarbonate.

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Esophageal Epithelial Resistance

• Mucus viscoelastic gel properties.
• A blood flow in sub-epithelial layer.

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Upper Epithelial Sphincter

• Cricopharyngeal muscle (tonic contraction)
• Increase with decrease PH.
• Decrease with sleep.
• Increase with inspiration.

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Pathogenesis of GERD

• Decreased Lower Esophageal Sphincter pressure.
• Abnormal Esophageal motility
• Abnormal or reduced mucosal resistance.
• Delayed gastric emptying.
• Increases intra-abdominal pressure.
• Gastric hypersecretion (acid or pepsin).

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Decreased Lower Esophageal Sphincter pressure

• Hiatal hernia
• Diet
• Fat.
• Mint.
• Cola.
• Cafine.
• Alcohol.
• Drugs
• Theophyline.
• Lidocaine.
• Diazepam.
• Progesterone.
• Ca-channel blocker.

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Abnormal Esophageal motility

• Delayed esophageal emptying causing abnormal acid
  clearance duo to decrease peristaltic wave
  amplitude.
• Neuromuscular disease.
• Laryngectomy.
• Ethanol.
• GERD.

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Decreased Mucosal Resistance

• Xerostomia
• Sicca syndrom
• Oral cavity radiation.
• Esophageal radiation.
• Autoimmune disease
• Cystic fibrosis.
• Systemic sclerosis
• Scleroderma.

• Tobacco
• Ethanol
• Drugs
• GERD

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Delayed Gastric Emptying

• Outlet obstruction Ulcer. Neoplasm.Neurogenic.
• Volume of feeding (childern).
• Diat (Fat).
• Tobacco.
• Ethanol.

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Increased Intraabdominal Pressure

• Tight clothing.
• Diet Over eating, carbonated beverage.
• Obesity.
• Pregnancy.
• Occupation.
• Exercise.

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GASTRIC HYPERSECRETION

• Stress trauma ,surgery, lifestyle.
• Tobacco.
• Ethanol.
• Drugs.
• Diet.

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Diagnostic tests of GERD

• Ambulatory 24h double probe PH monitoring.
• Barium esophagography with videofluroscopy.
• Endoscopy.
• Mucosal biopsy.
• Radionuclide scan.
• Acid perfusion.

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The otolaryngologic manifestation of GERD

• 10-50 of ORL laryngeal complaint have GERD.
• PH metry ve in 78.
• Esophagoscopy ve in 27.

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Common Presenting Symptoms

• Hoarseness 71
• Chronic couph 51
• Globus pharyngeus 47
• Heart burn / regurgitation 43
• Chronic throat clearing 42
• Dysphagia 35

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• 57 Denied heartburn.
• 75 Denied GI symptoms.

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ENT Diseases associated with GERD

• Carcinoma of the larynx.
• (cigarette smoking, alcohol
  intake)
• Decrease LES pressure.
• Impair mucosal resistance.
• Delay gastric emptying.
• Stimulate gastric hypersecretion.

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ENT Diseases associated with GERD

• Glottic and subglottic stenosis
• mature or immature legions

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ENT Diseases associated with GERD

• Hoarseness.
• Laryngitis.

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ENT Diseases associated with GERD

• Globus pharyngeus
• Inflammation and swelling of laryngopharyngeal
  tissue.
• Referred discomfort from esophagitis.
• Reflex hypertonicity of the UES.

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ENT Diseases associated with GERD

• Cervical dysphagia

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ENT Diseases associated with GERD

• Chronic cough.
• Referral otalgia.
• Recurrent sinusitis.
• Recurrent nasal polypi.

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ENT Diseases associated with GERD

• Management.

• History.
• ENT examination.
• Investigation.

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ENT Diseases associated with GERDTreatment of
laryngopharyngeal GERD

• Dietary modification
• Life style modification
• Medication

• No eating 3h before sleep.
• Low fat diet.
• Avoidance of caffeine, mint, pop.
• No alcohol.
• Avoid overeating.
• Antacid.
• H2 blockers.

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Thank You