Globus pharyngis: Development of a symptom assessment scale

Deary, Ian J.; Wilson, Janet A.; Harris, M; MacDougall, G.

doi:10.1016/0022-3999(94)00104-d

Cited by 93 publications

(107 citation statements)

References 21 publications

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“…Prior evaluations for underlying causes of globus have largely focused on psychosomatic origins or the relationship with GERD. 2,13,14 It is only after the advent of HRM and the ability to better define the UES that attention is slowing shifting to motor evaluation. In the first study of its kind, normal respiratory variation of UES pressure was noted to be amplified in globus patients studied with HRM techniques.…”

Section: Discussionmentioning

confidence: 99%

Assessment of Upper Esophageal Sphincter Function on High-resolution Manometry

Peng

Patel

Kushnir

et al. 2015

Journal of Clinical Gastroenterology

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Background Globus is commonly encountered in clinical practice, but high-resolution manometry (HRM) characteristics are incompletely characterized. We evaluated HRM metrics in globus subjects, compared with age-matched and sex-matched dysphagia subjects and healthy controls. Study Twenty-four subjects with globus (53.3±2.3 y, 58% female) were compared with 24 age-matched and sex-matched subjects with nonobstructive dysphagia (52.5±2.5 y, 58% female), and 21 healthy controls (27.6±0.6 y, 52% female). Sphincter and segment anatomy, and pressure volume metrics assessed skeletal (proximal contractile integral) and smooth muscle contraction (distal contractile integral). Parameters significantly different across groups on univariate analysis were subjected to multivariate logistic regression and receiver-operating characteristic analysis to identify HRM predictors of globus. Results Upper esophageal sphincter (UES) postswallow residual pressures were highest in globus (2.6±0.5 vs. 2.3±0.5mm Hg in dysphagia and 0.6±0.6mm Hg in controls, P=0.03); 66.7% had recordable UES residual pressure, in contrast to 9.5% of controls, and 37.5% of dysphagia patients (P=0.0002). Although different from controls, UES length and basal pressure, and segment 1 parameters did not differ from dysphagia controls. In a multivariate model, measurable UES residual pressure (odds ratio, 6.33; 95% confidence interval, 1.79–25.96) independently predicted globus. Receiver-operating characteristic analysis identified a threshold of 0.4mm Hg UES residual pressure in segregating globus (sensitivity 66.7%, specificity 71.5%, positive predictive value 55.2%, and negative predictive value 80.0%). Conclusion HRM with measurement of UES residual pressure allows objective assessment of patients with globus sensation, and has potential to complement current diagnostic strategies.

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Section: Discussionmentioning

confidence: 99%

Assessment of Upper Esophageal Sphincter Function on High-resolution Manometry

Peng

Patel

Kushnir

et al. 2015

Journal of Clinical Gastroenterology

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“…Classically, patients describe a ball-like sensation in the throat, but others describe itching, swelling or the sensation of a scratch or hair in the back of the throat 21. The symptoms tend to occur in the absence of swallowing, thus distinguishing globus from dysphagia or odynophagia 2.…”

Section: Clinical Featuresmentioning

confidence: 99%

“…The symptoms tend to occur in the absence of swallowing, thus distinguishing globus from dysphagia or odynophagia 2. Globus often improves with eating, which may lead to weight gain 21. The distinction from dysphagia is an important one, as the diagnostic algorithm and need for endoscopy or barium radiology is different.…”

Section: Clinical Featuresmentioning

confidence: 99%

Managing a patient with globus pharyngeus

Harvey

Theron

Trudgill

2017

Frontline Gastroenterol

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A woman aged 47 years reported the feeling of a lump in her throat for the past year. The sensation was present intermittently and usually improved when she ate. She noted it was worse with dry swallows when she felt like a tablet was stuck in her throat. The sensation had become more persistent in recent weeks leading her to worry that she had cancer. She had no cough, sore throat or hoarseness. There were no precipitating factors and no symptoms of weight loss, dysphagia, odynophagia or change in her voice. She had smoked previously and rarely had heartburn. She had no other anxieties and was not under any unusual stress. She was initially assessed by an ear, nose and throat surgeon, who found no abnormalities on examination of her neck, throat and oral cavity. Nasolaryngoscopy was normal. An upper gastrointestinal endoscopy was organised and reported a hiatus hernia, but a 3-month trial of a proton pump inhibitor did not have any impact on her symptoms. The benign nature of her symptoms was discussed at her gastroenterology follow-up appointment. She was discharged back to primary care with a final diagnosis of 'globus'. A trial of speech therapy, cognitive behavioural therapy or amitriptyline would be recommended if her symptoms became more troublesome in future.

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“…The GETS [17], which provided both the primary and secondary outcomes, is a validated questionnaire used to assess throat symptom severity. Higher scores represent more severe symptoms.…”

Section: Methodsmentioning

confidence: 99%

Serotonin Transporter Gene (SLC6A4) Polymorphism May Be Associated with Chinese Globus Pharyngeus and Its Antidepressant Effects

et al. 2018

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Background: Although globus pharyngeus is not rare in clinical practice, little is known about its associated gene polymorphism. We investigated the association between the SLC6A4 polymorphism and globus pharyngeus and its response to treatment with antidepressants. Methods: A total of 84 patients were diagnosed with globus pharyngeus according to Rome III, and 160 healthy controls were genotyped for the SLC6A4 polymorphism using polymerase chain reaction amplification and agarose gel electrophoresis. All patients with globus were studied using high-resolution manometry pre-therapy. Globus patients were randomized into paroxetine or amitriptyline groups for a 6-week treatment and asked to complete the following pre- and post-therapy questionnaires: the Glasgow Edinburgh Throat Scale (GETS), the Pittsburgh Sleep Quality Index, and the Hamilton Rating Scale Anxiety/Depression. Treatment response was defined as a >50% reduction in the GETS scores. Results: A significant difference was observed in the globus S/S genotype with anxiety compared to that without anxiety (χ² = 14.579, p = 0.006). The L/S genotype showed a significant difference between high upper esophageal sphincter pressure (>104 mm Hg) and non-high upper esophageal sphincter pressure patients (χ² = 14.433, p = 0.006). A significant association between the S/S genotype and the response to antidepressant treatment was also observed, while patients with sleep disorders or depression showed no association. Conclusion: A significant association was observed between the S/S genotype of the SLC6A4 polymorphism and globus pharyngeus, suggesting that SLC6A4 is a potential candidate gene involved in the pathogenesis of globus pharyngeus.

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Globus pharyngis: Development of a symptom assessment scale

Cited by 93 publications

References 21 publications

Assessment of Upper Esophageal Sphincter Function on High-resolution Manometry

Assessment of Upper Esophageal Sphincter Function on High-resolution Manometry

Managing a patient with globus pharyngeus

Serotonin Transporter Gene (SLC6A4) Polymorphism May Be Associated with Chinese Globus Pharyngeus and Its Antidepressant Effects

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