1. Gastroesophageal Reflux Disease (GERD)
Presented by: Rachel Lang
April 15, 2003
ASC 823 C

2. GERD Often called reflux
It is the recurring backflow of acid from the stomach into the esophagus

3. 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

4. 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

5. 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

6. Diagnostics
Laryngoscopy
24-hour pH monitoring
Endoscopy

7. Symptoms of GERD Hoarseness Post-nasal drip Throat pain
Persistent cough
Throat clearing
Dysphagia
Globus sensation
Primary symptom is heart burn

8. Functionally Abusive Vocal Behaviors
Result from behaviors that attempt to compensate for hoarseness or irritation
This increases severity of original problem symptoms

9. Voice Problems Hoarseness Increase in muscle tension
Restricted vocal tone placement
Hard glottal attack
Glottal fry
Vocal process granulomas
Contact ulcers

10. Voice Therapy Easy onset Throat and neck stretching exercises
Change throat focus to face
Vocal hygiene
Reduce throat clearing

11. 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

12. Avoid Tobacco Foods high in fat Spicy food Alcohol
Caffeine & Chocolate
Activities that compress the abdomen

13. Pharmacotherapy Reduce acidity H2 Antagonists
Over the counter
Pepcid & Zantac
Proton Pump Inhibitors (PPI)
Prescription only
Prilosec, Prevacid, & Nexium

14. Surgery Nissen fundoplication Procedure that tightens the LES
Wraps the upper part of the stomach around the esophagus

15. Refrences
Ahuja, V., Lassen, L., & Yenchen, M. (1999, September). Head and neck manifestations of gastroesophageal reflux disease. American Family Physician, 60,
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
Greater Baltimore Medical Center. Reflux changes to the larynx.. Retrieved on April 1, 2003, from
Scripps Center for Voice and Swallowing. Gastroesophageal reflux disease. Retrived on April 1, 2003, from