The Serratus Muscle Has No Role in GERD or LPR Management
The serratus muscle (serratus anterior or serratus posterior) is not involved in the pathophysiology, diagnosis, or treatment of gastroesophageal reflux disease (GERD) or laryngopharyngeal reflux (LPR). This appears to be a misunderstanding or miscommunication about anatomical structures relevant to reflux disease.
Relevant Anatomical Structures in Reflux Disease
The confusion may stem from discussion of the upper esophageal sphincter (UES), which is the actual anatomical barrier relevant to LPR management:
Upper Esophageal Sphincter Compression Device
- An external UES compression device applies 20-30 mmHg of cricoid pressure, resulting in increased intraluminal UES pressure and enhancing this barrier to supraesophageal reflux 1.
- In a study of 31 patients with laryngeal symptoms, symptom improvement occurred in 31% after a 4-week course of PPI, and this increased to 55% after the UES compression device was added to PPI 1.
- Although not currently widely available for clinical use, UES compression devices may be useful for reduction of certain extraesophageal reflux symptoms 1.
Actual Treatment Framework for LPR
The evidence-based approach to LPR focuses on lifestyle modifications, acid suppression, and barrier therapies—none of which involve the serratus muscle:
For Patients WITH Typical GERD Symptoms Plus LPR
- Implement lifestyle modifications including weight loss if BMI >25, head of bed elevation, and avoiding meals within 3 hours of bedtime 1, 2.
- Start twice-daily PPI therapy (esomeprazole 40 mg twice daily, omeprazole 40 mg twice daily, pantoprazole 40 mg twice daily, or rabeprazole 20 mg twice daily) for 8-12 weeks 1, 2.
For Patients WITHOUT Typical GERD Symptoms
- Do not empirically prescribe PPIs, as multiple trials show no benefit over placebo for isolated LPR symptoms (relative risk 1.28; 95% CI 0.94-1.74) 1, 2.
- Consider early objective testing with ambulatory pH monitoring before initiating therapy 1.
- Laryngoscopy is mandatory before prescribing any antireflux medication for isolated LPR symptoms 2, 3.
Common Pitfall to Avoid
The most critical error would be confusing anatomical terminology and pursuing interventions targeting the serratus muscle, which has no connection to the upper aerodigestive tract or reflux pathophysiology. The relevant structures are the lower esophageal sphincter (LES) and upper esophageal sphincter (UES), not the serratus muscle 1.