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 (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/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