Transcript The Otolaryngologic Manifestation Of GERD Dr Khalil Sendi MD, FRCSC , FACS

The Otolaryngologic
Manifestation Of GERD
Dr Khalil Sendi
MD, FRCSC , FACS
ENT SURGEON
The Antireflux BARRIER
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Lower Esophageal Sphincter (LES).
Esophageal Acid Clearance.
Epithelial Resistance.
Upper Esophgeal Sphincter.
The lower Esophageal Sphincter
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Anatomic Factors:
Diaphragm “muscle sling”.
Cardiac angle.
Intra-abdominal Esophageal segment.
Phrenoesophageal ligment (H.H).
• Neural Innervation:
Causing relaxation of LES during swallowing.
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Hormonal factors:
Gastrin increase LES pressure.
Esophageal Acid Clearance
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Peristalisis.
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Saliva Bicarbonate.
Esophageal Epithelial Resistance
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Mucus viscoelastic + gel properties.
A blood flow in sub-epithelial layer.
Upper Epithelial Sphincter
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Cricopharyngeal muscle (tonic contraction)
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Increase with decrease PH.
Decrease with sleep.
Increase with inspiration.
Pathogenesis of GERD
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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).
Decreased Lower Esophageal
Sphincter pressure
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Hiatal hernia
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Diet:
Fat.
Mint.
Cola.
Cafine.
Alcohol.
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Drugs:
Theophyline.
Lidocaine.
Diazepam.
Progesterone.
Ca-channel blocker.
Abnormal Esophageal motility
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Delayed esophageal emptying causing abnormal acid
clearance duo to decrease peristaltic wave amplitude.
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Neuromuscular disease.
Laryngectomy.
Ethanol.
GERD.
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Decreased Mucosal Resistance
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Xerostomia:
Sicca syndrom
Oral cavity radiation.
Esophageal radiation.
Autoimmune disease:
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Cystic fibrosis.
Systemic sclerosis
Scleroderma.
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Tobacco
Ethanol
Drugs
GERD
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.
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 Obesity.
 Pregnancy.
 Occupation.
 Exercise.
GASTRIC HYPERSECRETION
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Stress: trauma ,surgery, lifestyle.
Tobacco.
Ethanol.
Drugs.
Diet.
Diagnostic tests of GERD
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Ambulatory 24h double probe PH monitoring.
Barium esophagography with videofluroscopy.
Endoscopy.
Mucosal biopsy.
Radionuclide scan.
Acid perfusion.
The otolaryngologic manifestation
of GERD
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10-50 % of ORL laryngeal complaint have GERD.
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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%
57%
Denied heartburn.
75% Denied GI symptoms.
ENT Diseases associated with GERD
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Carcinoma of the larynx.
(cigarette smoking, alcohol intake)
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Decrease LES pressure.
Impair mucosal resistance.
Delay gastric emptying.
Stimulate gastric hypersecretion.
ENT Diseases associated with GERD
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Glottic and subglottic stenosis:
mature or immature legions
ENT Diseases associated with GERD
Hoarseness.
 Laryngitis.
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ENT Diseases associated with GERD
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Globus pharyngeus:
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Inflammation and swelling of laryngopharyngeal tissue.
Referred discomfort from esophagitis.
Reflex hypertonicity of the UES.
ENT Diseases associated with GERD
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Cervical dysphagia
ENT Diseases associated with GERD
Chronic cough.
 Referral otalgia.
 Recurrent sinusitis.
 Recurrent nasal polypi.
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ENT Diseases associated with GERD
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Management.
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History.
ENT examination.
Investigation.
ENT Diseases associated with GERD
Treatment of laryngopharyngeal GERD
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Dietary modification
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Life style modification
Medication
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No eating 3h before sleep.
Low fat diet.
Avoidance of caffeine, mint,
pop.
No alcohol.
Avoid overeating.
Antacid.
H2 blockers.
Thank You