Gastroesophageal Reflux Disease (GERD)

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

GERD

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

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

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

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

Diagnostics

• Laryngoscopy • 24-hour pH monitoring • Endoscopy

Symptoms of GERD

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

Functionally Abusive Vocal Behaviors

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

Voice Problems

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

Voice Therapy

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

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) • Don’t lie down right after meals • Maintain a healthy weight

Avoid

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

Pharmacotherapy

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

Surgery

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

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

(6 th 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/webtherapy/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/printfriendly article.htm