Transcript Gastroespohageal Reflux Disease (GERD) & Laryngopharyngeal

Gastroespohageal Reflux
Disease (GERD) &
Laryngopharyngeal Reflux
Disease (LPRD)
Michelle Dotto
April 3, 2003
Voice Disorders ASC 823C
What are they?
 The term REFLUX comes from
the Greek word meaning
“backflow,” usually referring to the
contents of the stomach.
 Just under the diaphragm, where
the esophagus and stomach
connect, is the lower esophageal
sphincter (LES). This muscle
normally prevents stomach juices
and food from coming back up,
relaxing only when you swallow.
 GERD: an abnormal amount of
reflux up through the lower
sphincters and into the
esophagus.
 LPRD: when the reflux passes all
the way through the upper
sphincter and into the back of the
throat, reaching the larynx and
pharynx.
Symptoms for GERD
 The most common is a burning sensation in the chest,
usually after eating (AKA heartburn). This sensation can
also be associated with position, sleep, or exercise.
 Others include: belching, dysphagia, odynophagia (pain
on swallowing), water brash, sore throat, cough,
bronchospasms, atypical chest pain, hoarseness, and
asthma exacerbation.
 Symptoms are more common over night
 Most common symptoms in the elderly include
dysphagia, vomiting, and respiratory problems, among
others which all lead to restrictive respiratory problems.
Symptoms of LPRD
 Symptoms of the two may overlap, however, the
pharynx, larynx, and lungs are more sensitive to
stomach acid and digestive enzymes allowing
less reflux to do more damage.
 Symptoms include: hoarseness, frequent throat
clearing, sensation in the throat, bad/bitter taste
in the mouth, referred ear pain, and post-nasal
drip to name a few.
 Symptoms are commonly experienced during
the day.
 Very few experience heartburn.
Signs that may be seen by a professional
 Red, irritated
arytenoids
 Red, irritated larynx
 Small laryngeal ulcers
 Swelling of the VF
 Granulomas in the
larynx
Severe, long term affects
Gastrointestinal bleeding
Barrett’s esophagus
There is columnar epithelium in the esophagus
where stratified squamous epithelium should be
Cancer
Causes
 Medications or food that relax the LES:
Chocolate
Caffeine
Fatty/spicy foods
Onions
Mint
Alcohol
Acidic fruits and vegetables
 Hiatal hernia may also prevent closing of the LES –
when the stomach protrudes above the diaphragm
Treatment
Prevention/Lifestyle changes
Medications
Surgery
Prevention/Lifestyle changes
 The most important step is to minimize exposure to
those factors that interfere with the normal function of the
esophageal sphincter.
 Meals should be eaten at least 2 hours before bedtime to
prevent stomach acids from moving up the esophagus.
 Do not exercise immediately after a meal
 Maintain a healthy body weight
 Reduce stress
 Elevate the head of the bed 4-6 inches. Simply sleeping on extra
pillows does not help since it flexes the stomach and could
actually worsen reflux. Tilting the entire bed upwards will allow
gravity to do its job.
 Avoid tight clothing
 Do not smoke
Medications
 reduce the acidity of
the stomach contents
 increase the activity
of the esophageal
sphincters
 they will increase the
motility of the
stomach
Medications Continued
 “acid-blockers”
They don’t reduce reflux but they do reduce acidity.
 "H-2 blockers” :block the histamine 2 receptor that is
important in stomach acid production
• Tagamet
• Zantac
• Pepcid
 Proton pump inhibitor (PPI): reduce activity of a process
that "pumps" protons across the cell membrane
• Prilosec
• Prevacid
 Reglan is also used to increase the activity of the
sphincter and increase gastric motility
Surgery
With severe cases when meds and other
tx are not successful.
Most common procedure: fundoplication,
sewing a portion of the stomach around the
esophagus to tighten its lower end. This
operation can be done through small incisions
in the abdomen using endoscopes.
Diagnosis
Tests completed:
pH monitoring (AKA pH-metry)
Takes 24 hours (over night)
Measure acid in esophagus and throat
Small, soft, fexible tube (pH probe) through the nose
and into the throat which is connected to a small
computer worn around the waist
Also allows doctors to determine the best treatment
Barium swallow
Easiest, most cost effective
However, may be misleading
How is the voice affected?
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Hoarseness
Vocal fatigue
Edema
Ulceration
Granulation
Polypoid degeneration
Vocal nodules
Laryngospasm
Arytenoid fixation
Laryngeal stenosis
Carcinoma of the larynx
Voice treatment
Responsible for providing support for the
reflux and appropriate voice therapy.
Acute stages of voice change: decrease
throat clearing and coughing, conserve
voice use, initiating new functional voicing
behaviors.
Resonant Voice Therapy
References
 Center for Voice Disorders of Wake Forest University. (2003).
Patient information sheet on reflux.
http://www.bgsm.edu/voice/pt_info.html
 Columbia Presbyterian Medical Center. (2002). Laryngopharyngeal
reflux disease and recommendations to prevent acid reflux.
http://www.entcolumbia.org/lprd.htm
 Hensrud, D.D. (2002). Somethings burning [Electronic version].
Fortune, 146, issue I.
 Levy, R.A., Meiner, S.E., & Stamm, L. (2002). Conservative
management of GERD: a case study. Medsurg Nursing, 11, No. 4.
 Stemple, J., Gerdeman, B.K., & Glaze, L. (2002). Clinical Voice
Pathology: Theory and Management. 3rd ed. Singular Publishing
 Voice Center. (2003). Reflux disease and its effects on the larynx.
http://www.voice-center.com/reflux.html