Worsening of gastroesophageal reflux symptoms in professional singers during performances

Professional singers perform singing tasks requiring rapid changes of subglottal pressure with consistent use of the diaphragm. They regularly activate the diaphragm when there is a need for a rapid decrease in subglottal pressure, with an abrupt and prolonged increase in intraabdominal pressure. We describe the occurrence of stress-induced gastroesophageal reflux disease (GERD) in four professional singers. The reflux symptoms, which occurred in these patients during vocal performances, were an important obstacle to the movement of the respiratory muscles. To our knowledge, these are the first case reports of worsening of GERD symptoms in professional singers during performances.