High incidence of esophageal motor disorders in consecutive patients with globus sensation

Moser, Gabriele; Vacariu-Granser, Gerda Viktoria; Schneider, Christa; Abatzi, Thalia-Anthi; Pokieser, Peter; Stacher-Janotta, Giselheid; Gaupmann, G; Weber, Ute; Wenzel, Thomas; Roden, Michael; Stacher, G

doi:10.1016/0016-5085(91)90386-y

Cited by 47 publications

(18 citation statements)

References 34 publications

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“…Although the Kwiatek et al’s 7 study did not identify distal esophageal motor abnormalities, another study found spastic processes in the distal esophagus in 27 of 30 patients with globus. 15 Although minor motor disorders were seen in globus patients, proportions were not different from dysphagia patients, and the true significance of esophageal body motor patterns needs further study in a larger cohort of patients.…”

Section: Discussionmentioning

confidence: 88%

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: 88%

Assessment of Upper Esophageal Sphincter Function on High-resolution Manometry

Peng

Patel

Kushnir

et al. 2015

Journal of Clinical Gastroenterology

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“…These systems can be used alone or combined with fluoroscopy to help define both normal physiology and the pathophysiology of disorders affecting this region [6]. Manometric abnormalities are being defined in disorders such as globus sensation [7], Parkinson's disease [8], and cricopharyngeal bar [3]. The routine application of this technique to patients referred for manometry has led to the reevaluation of esophageal disorders that were once thought not to involve the striated muscle portions of the esophagus.…”

Section: Discussionmentioning

confidence: 99%

Incomplete Upper Esophageal Sphincter Relaxation: Association with Achalasia but Not Other Esophageal Motility Disorders

DeVault

1997

Dysphagia

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Incomplete upper esophageal sphincter (UES) relaxation is not well understood. We compared clinical and manometric characteristics of patients with normal and abnormal UES relaxation. Consecutive patients (n = 208) underwent manometric evaluation of the lower esophageal sphincter (LES), esophageal body, and UES/pharynx. The patients were divided into those with abnormal UES relaxation (residual pressure > 6.7 mmHg) (n = 21) and normal relaxation (n = 187). Clinical and manometric profiles were compared. Sex, age, and presenting complaint did not correlate with UES relaxation. Normal esophageal peristaltic sequences were more frequently present in the normal UES group (73.6%) compared with the abnormal (55.8%) (p < 0.01). The UES relaxation was shorter in the group with abnormal relaxation (410.0 ms vs. 510.2 ms, p < 0.001). All other manometric parameters were not different between the two groups. When individual manometric diagnoses were analyzed, only achalasia was noted to be more common in the abnormal UES group (23.8% vs. 9.1%, p < 0.05), and a trend was noted toward diffuse esophageal spasm being more common (14.3% vs. 9.6%, not significant). We conclude that incomplete UES relaxation is a rare manometric finding, associated with achalasia and not specifically associated with any other motility disturbance. This finding may represent a secondary response to the poor esophageal emptying seen in achalasia.

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“…29 Thus, the stimulation of receptors in the distal esophagus by gastric refluxate leads to vagal reflex and bronchial constriction. 28 …”

Section: Pathophysiologic Relation Of the Disordersmentioning

confidence: 97%

“…These include the reflux theory that suggests direct stimulation of airway inflammation by aspiration of gastric contents or airway hyperresponsiveness triggered by aspiration of minute amounts of acid into the lower airway. [22][23][24][25][26][27][28] The acidic nature of the refluxate, presence of food allergens, and digestive enzymes may promote inflammation of the airways and smooth muscle tissues leading to heightened bronchial smooth muscle reactivity. 27 The basis of the reflex theory is that the common embryologic origins of the respiratory and gastrointestinal systems result in shared innervention via the vagus nerve and thereby share similar autonomic reflexes.…”

Section: Pathophysiologic Relation Of the Disordersmentioning

confidence: 99%

Asthma and gastroesophageal reflux disease in children: Exploring the relationship

Gold

2005

The Journal of Pediatrics

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High incidence of esophageal motor disorders in consecutive patients with globus sensation

Cited by 47 publications

References 34 publications

Assessment of Upper Esophageal Sphincter Function on High-resolution Manometry

Assessment of Upper Esophageal Sphincter Function on High-resolution Manometry

Incomplete Upper Esophageal Sphincter Relaxation: Association with Achalasia but Not Other Esophageal Motility Disorders

Asthma and gastroesophageal reflux disease in children: Exploring the relationship

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