Consultants in Dysphagia Evaluation and Management
817-514-MBS1 or 1-888-514-MBS1
By: Ronda Polansky M.S. CCC-SLP
Heartburn is a common problem in the United States and in the Western world. Approximately 7% of the population experience symptoms of heartburn daily. An abnormal esophageal exposure to gastric juice is probably present in 20-40% of this population, meaning 20-40% of the people who experience heartburn do indeed have GERD. In the remaining population, heartburn is probably due to other causes. Because many individuals control symptoms with over-the-counter medications and without consulting a medical professional, the condition is likely underreported.
GERD – Gastroesophageal Reflux is defined as the retrograde movement of gastric contents from the stomach through the lower esophageal sphincter and into the esophagus. The most common symptom is “heart burn”.
Persons with GERD frequently complain of:
1. Non cardiac chest pain, heartburn
3. Waterbrash (stimulated salivary secretions by esophageal acid),
4. Odynophagia (pain when swallowing),
5. Acid regurgitation
6. Globus sensation
GERD occurs through one of three mechanisms
1. Inappropriate or transient lower esophageal sphincter relaxation
2. Increased abdominal pressure or stressed induced reflux
3. Incompetent or reduced lower esophageal sphincter pressures or spontaneous free reflux.
Lower esophageal sphincter competence is the most important barrier to esophageal reflux.
LPR – Laryngopharyngeal Reflux is an inflammatory disease of the larynx but it originates in the stomach like other reflux disorders. Acid from the stomach rises up to the level of the laryngopharynx and targets the laryngeal tissues to cause a number of disorders.
Difference between GERD and LPR – Persons with LPR frequently complain of:
1. Occurs when a person is upright
2. Occurs during the daytime
3. Presents with the symptoms of dysphagia,
6. Globus sensation
7. Shortness of breath
8. Air hunger
10. Pulmonary aspiration
11. Coughing, but usually without the specific complaint of heartburn.
RSI – Reflux Symptom Index
Within the last MONTH how did the following affect you?
1. Hoarseness or voice changes 0 1 2 3 4 5
2. Clearing your throat 0 1 2 3 4 5
3. Excess throat mucus or postnasal drip 0 1 2 3 4 5
4. Difficulty swallowing foods, liquids, or pills 0 1 2 3 4 5
5. Coughing after you ate or after lying down 0 1 2 3 4 5
6. Breathing difficulties or choking episodes 0 1 2 3 4 5
7. Troublesome or annoying cough 0 1 2 3 4 5
8. Something sticking in throat or lump in throat 0 1 2 3 4 5
9. Heartburn, chest pain, indigestion 0 1 2 3 4 5
A score greater than 10 strongly suggests that the patient has laryngopharyngeal reflux (LPR).
1. Stop smoking
2. Avoid foods and beverages that worsen symptoms.
3. Avoiding alcohol, chocolate, citrus juice, and tomato-based products
4. Lose weight if needed.
5. Eat small, frequent meals.
6. Wear loose-fitting clothes.
7. Avoid lying down for 3 hours after a meal.
8. Raise the head of your bed 6 to 8 inches by securing wood blocks under the bedposts. Just using extra pillows will not help.
Medications: A health care provider may recommend over-the-counter antacids or medications that stop acid production or help the muscles that empty your stomach. Many of these medications can be obtained without a prescription.
1. Antacids, such as Alka-Seltzer, Maalox, Mylanta, Rolaids, and Riopan, are usually the first drugs recommended to relieve heartburn and other mild GERD symptoms. Antacids, however, can have side effects. Magnesium salt can lead to diarrhea, and aluminum salt may cause constipation. Aluminum and magnesium salts are often combined in a single product to balance these effects. Calcium carbonate antacids, such as Tums, Titralac, and Alka-2, can also be a supplemental source of calcium. They can cause constipation as well.
2. Foaming agents, such as Gaviscon, work by covering your stomach contents with foam to prevent reflux.
3. H2 blockers, such as cimetidine (Tagamet HB), famotidine (Pepcid AC), nizatidine (Axid AR), and ranitidine (Zantac 75), decrease acid production. They are available in prescription strength and over-the-counter strength. These drugs provide short-term relief and are effective for about half of those who have GERD symptoms.
4. Proton pump inhibitors include omeprazole (Prilosec, Zegerid), lansoprazole (Prevacid), pantoprazole (Protonix), rabeprazole (Aciphex), and esomeprazole (Nexium), which are available by prescription. Prilosec is also available in over-the-counter strength. Proton pump inhibitors are more effective than H2 blockers and can relieve symptoms and heal the esophageal lining in almost everyone who has GERD.
5. Prokinetics help strengthen the LES and make the stomach empty faster. This group includes bethanechol (Urecholine) and metoclopramide (Reglan). Metoclopramide also improves muscle action in the digestive tract. Prokinetics have frequent side effects that limit their usefulness—fatigue, sleepiness, depression, anxiety, and problems with physical movement.
Because drugs work in different ways, combinations of medications may help control symptoms. People who get heartburn after eating may take both antacids and H2 blockers. The antacids work first to neutralize the acid in the stomach, and then the H2 blockers act on acid production. By the time the antacid stops working, the H2 blocker will have stopped acid production. Your health care provider is the best source of information about how to use medications for GERD.
Murray, Thomas, Carrau, Ricardo, Clinical, management of Swallowing Disorders, Second Edition, 2006