Esophageal Motility Studies in Globus Sensation

Caldarelli, David D.; Andrews, Albert H.; Derbyshire, A. J.

doi:10.1177/000348947007900612

Cited by 48 publications

(24 citation statements)

References 3 publications

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“…Some studies have reported increased UES pressure in globus patients (9,15,16), a finding not confirmed by others (17–19). Pilot data in our laboratory utilizing high-resolution manometry (HRM) showed that patients reporting globus may exhibit an exaggerated increase in UES pressure during inspiration relative to expiration, or occasionally a reversal of this pattern with augmentation occurring during expiration.…”

Section: Introductionmentioning

confidence: 72%

Hyperdynamic Upper Esophageal Sphincter Pressure: A Manometric Observation in Patients Reporting Globus Sensation

et al. 2009

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OBJECTIVES-Although globus sensation is a common symptom, its pathogenesis is poorly defined. The aim of this study was to quantify the timing and magnitude of respiratory variation in upper esophageal sphincter (UES) pressure with high-resolution manometry (HRM) in patients with globus sensation, normal controls, and gastroesophageal reflux disease (GERD) patients without globus sensation.METHODS-HRM recordings spanning from the hypopharynx to the stomach were analyzed in 131 consecutive globus patients with normal (64) and abnormal (67) distal esophageal motility. Resting UES pressure was analyzed up to 5 min before 10 5-ml water swallows. Change in UES pressure, its average magnitude between inspiration and expiration, and nadir UES relaxation pressure in globus patients were compared with those in 68 controls and 46 GERD patients without globus. RESULTS-UES pressure typically increased during inspiration in both controls and patients.Respiration-related change in resting UES pressure was significantly amplified in globus patients (37.3 mm Hg) compared with controls (10.6 mm Hg) and GERD patients (13.0 mm Hg) (P < 0.0001). A respiratory change in UES pressure >27 mm Hg was found in > 60% of globus patients and <15% of controls and GERD patients without globus. This hyperdynamic UES was not associated with other abnormalities of esophageal motor function.CONCLUSIONS-Hyperdynamic respiratory UES pressure changes were prevalent in patients reporting globus sensation irrespective of their deglutitive UES and distal esophageal motility. Although the etiology of this hyperdynamic UES is unclear, it does appear to be a frequent manometric observation in this patient group and may provide a new focus for further studies into pathogenesis and therapy.

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Section: Introductionmentioning

confidence: 72%

Hyperdynamic Upper Esophageal Sphincter Pressure: A Manometric Observation in Patients Reporting Globus Sensation

et al. 2009

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“…In 1940s, cricopharyngeal spasm was a favoured cause. Nevertheless, manometric studies in later years found no supporting evidence [3]. However, this is contradicted by study of Gray [4] where he stated that cricopharyngeal muscle sphincter pressures measured using manometry revealed statistically significant differences between those with globus and controls.…”

Section: Introduction and Literature Reviewmentioning

confidence: 95%

Positive findings on barium swallow in patients presenting with a “sensation of a lump in the throat”

Mahrous

Kaoutzanis

Amin

et al. 2011

Eur Arch Otorhinolaryngol

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Our objective is to evaluate the pickup rate of a significant pathology, on barium swallow, in patients who present to our clinic with a feeling of a lump in the throat (globus symptoms). Hospital--secondary referral centre. This is a retrospective study of 192 patients who had barium swallow in our department between August 2009 and August 2010. We revised 500 case notes to rule in 192 who presented with only a feeling of a lump in their throat. All patients with positive clinical findings, such as dysphagia, odynophagia, referred otalgia, hoarseness of voice, weight loss, neck swelling or vocal cord palsy, were ruled out. Eight patients were diagnosed on barium swallow as having significant pathology: five with diverticulae and three patients with oesophageal web. The percentage of significant pathology in our study is 4.17% (eight patients). Out of those eight cases, there was no malignant pathology identified on further panendoscopy. Our conclusion is that barium swallow adds very little to the diagnosis of Globus Pharyngeus, but it plays a role in the reassurance particularly from the patients' perspective.

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“…In a recent study of high-resolution manometry in patients with globus sensation, normal controls, and GERD patients without globus sensation, hyperdynamic respiratory UES pressure changes were most prevalent in patients reporting globus sensation (28). However, results regarding to the UES function in patients with globus sensation were inconsistent because of a small number of subjects enrolled and differences in modalities used in each study (30,31,32). …”

Section: Potential Causes Of Globus Sensationmentioning

confidence: 99%

Pathophysiology and treatment of patients with globus sensation —from the viewpoint of esophageal motility dysfunction—

Manabe

Tsutsui

Kusunoki

et al. 2014

J. Smooth Muscle Res.

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"Globus sensation" is often described as the sensation of a lump in the throat associated with dry swallowing or the need for dry swallowing, which disappears completely during eating or drinking and for which no organic cause can be established. Due to the uncertain etiology of "globus sensation", it remains difficult to establish standard treatment strategies for affected patients. Lately most attention has been focused on gastroesophageal reflux disease and several reports have indicated that there is a close relationship between esophageal acid reflux and globus sensation. Nowadays, empirical therapy with a high dose of a proton pump inhibitor (PPI) is considered to be indicated for patients with globus sensation, after excluding organic diseases such as pharyngeal cancer, Zenker's diverticulum, or thyroid enlargement. If patients are nonresponsive to PPI therapy, evaluation of esophageal motility should be done. In our recent study, 47.9% had abnormal esophageal motility, with the most common esophageal motility abnormality being an ineffective esophageal motility in PPI-resistant patients with globus sensation. This suggests that prokinetics alone or adding prokinetics to PPI should be the treatment to be considered, although few studies have investigated the efficacy of prokinetics in the treatment of patients with globus sensation. If patients without any esophageal motility dysfunctions are nonresponsive to PPI therapy, either cognitive-behavioral therapy, anti-depressants, or gabapentin could be helpful, although further well-designed, randomized controlled large-scale studies will be necessary to determine the effectiveness of each treatment strategy on patients with globus sensation.

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Esophageal Motility Studies in Globus Sensation

Cited by 48 publications

References 3 publications

Hyperdynamic Upper Esophageal Sphincter Pressure: A Manometric Observation in Patients Reporting Globus Sensation

Hyperdynamic Upper Esophageal Sphincter Pressure: A Manometric Observation in Patients Reporting Globus Sensation

Positive findings on barium swallow in patients presenting with a “sensation of a lump in the throat”

Pathophysiology and treatment of patients with globus sensation —from the viewpoint of esophageal motility dysfunction—

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