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
Barretts 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
Medications
Surgery

changes

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 dont 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
pH

completed:

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?

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