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39: GASTROESOPHAGEAL REFLUX DISEASE

Debra F. Stern, DPT, DBA, MSM, PT; Eric Shamus, PhD, DPT, PT, CSCS

CONDITION/DISORDER SYNONYMS

  • Gastroesophageal reflux disease (GERD)

  • Reflux esophagitis

ICD-9-CM CODES

  • 530.81 Esophageal reflux

  • Associated physical therapy diagnoses

    • 315.4 Developmental coordination disorder

    • 718.45 Contracture of joint, pelvic region and thigh

    • 719.70 Difficulty in walking

    • 728.2 Muscular wasting and disuse atrophy, not elsewhere classified

    • 728.89 Disorders of muscle, ligament, and fascia

    • 729.9 Other and unspecified disorders of soft tissue

    • 780.7 Malaise and fatigue

    • 781.2 Abnormality of gait

    • 782.3 Edema

    • 786.0 Dyspnea and respiratory abnormalities

    • 786.05 Shortness of breath

ICD-10-CM CODE

  • K21.9 Gastroesophageal reflux disease without esophagitis

PREFERRED PRACTICE PATTERN

  • As of June, 2014, the APTA Guide to Physical Therapist Practice does not include practice patterns for organ system pathology; therefore, the associated or secondary musculoskeletal, cardiovascular/pulmonary, or potential neuromuscular patterns would be indicated.

FIGURE 39-1

Algorithm for the diagnosis and treatment of gastroesophageal reflux (GERD). bid, twice daily; EGD, esophagogastroduodenoscopy; H2RA, H2-receptor antagonist; OTC, over-the-counter; prn, as needed; qd, daily. (From Greenberger NJ, Blumberg RS, Burakoff R. Current Diagnosis & Treatment: Gastroenterology, Hepatology, & Endoscopy, 2nd ed. www.accessmedicine.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)

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PATIENT PRESENTATION

A 60-year-old patient is referred to PT with general shoulder pain. He plays softball in a senior league and somehow injured his shoulder. Although he cannot be specific about any single event or injury, he plays first base and occasionally fills in for the pitcher. He is moderately obese, but does go regularly to the gym to work out. His medications include an ace inhibitor for high blood pressure and occasional antacids for heartburn. During the initial examination he is rubbing the front of his shoulder and pectoralis area on the right. Hiccups and occasional coughing interfere with conversation at times, and he complains that he suffers from them more and more often. He is anxious to get better as his team is in the playoffs. Physical examination reveals bursitis and soreness in both shoulders.

KEY FEATURES

Description

  • Condition in which stomach acid backs up into esophagus

  • Patients experience burning feeling in abdominal, chest, or throat areas

  • Common symptom and complaint is “heartburn”

Essentials of Diagnosis

  • Acid reflux or indigestion, minimum twice weekly1

  • Inability to or difficulty with swallowing

  • Burning in chest

  • Hoarseness

  • Sore throat

  • Regurgitation of food or sour liquid (acid reflux)

  • Complaint of lump in throat

  • Cough without mucous production or congestion

  • Chest pain

  • Nausea, vomiting

General Considerations

  • Broad array of GI disorders may be encountered by physical therapists

  • While PT may not manage GI disorders specifically, clients may receive care for secondary problems: Weakness, gait abnormalities, limited ...

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