Gastroesophageal reflux disease

• GERD
• Reflux esophagitis

• 530.81 Esophageal reflux

• 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

• K21.9 Gastro-esophageal reflux disease without esophagitis

• As of November 2012, 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.

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 aerobic endurance, sarcopenia, musculoskeletal/ neuromuscular problems, weight loss/gain
  • Problems may be acute, post-operative, chronic, viral, bacterial, or congenital/hereditary
• PT should recognize possible GI pathology in differential diagnosis, especially when findings are inconsistent with conditions commonly treated
• GI disorders frequently refer pain to other body areas; individuals may be inappropriately referred to PT
• History of heartburn or indigestion may indicate GI or cardiac problems
• May lead to more serious conditions such as Barrett’s esophagus
• May increase risk of cancer or ulcer

Demographics

• GI disorders occur throughout lifespan (birth through geriatric)
• 55 to 60% of general population suffer from occasional symptoms of GERD2
• Some indication of genetic tendency
• Depending on the pathology, occurrence rates may differ based on ethnicity, diet, lifestyle, gender, age
• High incidence in general population due to potential for lifespan occurrence

Signs and Symptoms

• Chronic indigestion
• Burning in throat, heartburn
• Relief with antacids
• Indigestion at least twice weekly
• Symptoms worsen when lying flat
• Wheezing
• Hiccups
• Difficulty swallowing (related to esophageal or oral problems rather than neuromuscular)
• Pain
  • Abdominal/stomach pain, cramping (constant or intermittent, severe)
  • Chest pain
  • Pain upon ingesting food or liquid
    • May be cardiac in nature
  • Pain after ingesting fatty foods (gallbladder sign)
• Bowel changes
  • Diarrhea (acute, chronic)
  • Constipation (acute, chronic), especially with antacid ingestion
  • Occult blood in stool
  • Change in stool odor or color
  • Mucous in stool or mucous discharge
• Unexplained weight loss
• Abdominal muscle spasm, guarding
• Fatigue
• Loss of appetite, cachexia, ...