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Gastroespohageal Reflux Disease (GERD) & Laryngopharyngeal Reflux Disease (LPRD)

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Gastroespohageal Reflux Disease (GERD) & Laryngopharyngeal Reflux Disease (LPRD) Michelle Dotto April 3, 2003 Voice Disorders ASC 823C What are they? – PowerPoint PPT presentation

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Title: Gastroespohageal Reflux Disease (GERD) & Laryngopharyngeal Reflux Disease (LPRD)


1
Gastroespohageal Reflux Disease (GERD)
Laryngopharyngeal Reflux Disease (LPRD)
  • Michelle Dotto
  • April 3, 2003
  • Voice Disorders ASC 823C

2
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.

3
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.

4
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.

5
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

6
Severe, long term affects
  • Gastrointestinal bleeding
  • Barretts esophagus
  • There is columnar epithelium in the esophagus
    where stratified squamous epithelium should be
  • Cancer

7
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

8
Treatment
  • Prevention/Lifestyle changes
  • Medications
  • Surgery

9
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

10
Medications
  • reduce the acidity of the stomach contents
  • increase the activity of the esophageal
    sphincters
  • they will increase the motility of the stomach

11
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

12
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.

13
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

14
How is the voice affected?
  • Hoarseness
  • Vocal fatigue
  • Edema
  • Ulceration
  • Granulation
  • Polypoid degeneration
  • Vocal nodules
  • Laryngospasm
  • Arytenoid fixation
  • Laryngeal stenosis
  • Carcinoma of the larynx

15
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

16
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
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