High-resolution manometry in patients with and without globus pharyngeus and/or symptoms of laryngopharyngeal reflux

Abstract

BackgroundGlobus pharyngeus is common and has a low cure rate. Its etiology is complex and reported to be associated with laryngopharyngeal reflux (LPR). However, some patients with globus do not exhibit any reflux symptoms or respond to proton pump inhibitors (PPIs) treatments. The purpose of this study was to clarify the related risk factors of these patients with a final objective of improving the curative effect.MethodsForty two patients afflicted with globus pharyngeus (G group) and 38 patients without globus pharyngeus (NG group) were included in this study. According to the laryngopharyngeal Reflux Symptom Index and the response to PPIs treatments, the patients were further divided into reflux groups (G-R, NG-R) and non-reflux groups (G-NR, NG-NR). High Resolution Manometry (HRM) was performed to assess esophageal motility. Questionnaires, including categories such as life exposure factors, were conducted.Results a) The average resting and residual pressures of the upper esophageal sphincter (UES) in the G-NR group was higher than in the NG-NR and NG-R groups (P < 0.05). b) The average resting and residual pressures of the lower esophageal sphincter showed no differences between the G-NR group and the NG-NR group (P > 0.05). c) The esophageal distal contractile integral score of the G-NR group was not different from the NG-NR group (P > 0.05). d) Compared to the NG-NR group, the G-NR group showed higher incidence of stress, smoking, drinking, high salt and anxiety (P < 0.05).ConclusionsGlobus pharyngeus without LPR may occur due to high UES pressure. Stress, smoking, alcoholic drinking, high salt and anxiety may be its risk factors.Electronic supplementary materialThe online version of this article (10.1186/s12876-017-0666-x) contains supplementary material, which is available to authorized users.

Correlating videofluoroscopic swallow study findings with subjective globus location

“…Gastroenterology research has focused largely on investigating the association of GERD with globus symptoms using manometry and dual‐channel impedance studies. Although these studies have established a correlation between GERD and globus, no causal relationship has been established, particularly when focusing on extraesophageal reflux symptoms and findings . The otolaryngology approach to globus pharyngeus is somewhat distinct from that of gastroenterologists because otolaryngologists rule out oropharyngeal, laryngeal, and upper aerodigestive malignancy, although multiple recent studies have shown an exceedingly low likelihood of malignancy in patients with typical globus symptoms .…”

“…Although these studies have established a correlation between GERD and globus, no causal relationship has been established, particularly when focusing on extraesophageal reflux symptoms and findings. 11,12 The otolaryngology approach to globus pharyngeus is somewhat distinct from that of gastroenterologists because otolaryngologists rule out oropharyngeal, laryngeal, and upper aerodigestive malignancy, although multiple recent studies have shown an exceedingly low likelihood of malignancy in patients with typical globus symptoms. 10,13,14 A retrospective review of 250 cases of rigid endoscopy performed for primary globus failed to reveal any malignancies.…”

Elevation of Lower Esophageal Sphincter Pressure With Acute Transcutaneous Electrical Acustimulation Synchronized With Inspiration

“…The catheter was then fixed with tape to the patient's nose followed with a 5‐minutes period of adaptation. The HRM recording was made in the supine position with a 30‐sec basal period with no deglutition in order to obtain the sphincter resting pressures, followed by a total of ten water (5 mL) swallows at 30 sec intervals seconds .…”

ESNM/ANMS Review. Diagnosis and management of globus sensation: A clinical challenge

“…Esophageal motor abnormalities, particularly pertaining to the upper esophageal sphincter (UES) have been described in globus, but it remains unclear if the findings are causative of the symptom, or a consequence of concurrent anxiety. A reactive, hyperdynamic UES with respiration, 21 high UES resting pressures, 22 and elevated UES postswallow residual pressures 23,24 have been reported. There are limited data demonstrating that a lowering of UES pressure with neuromodulator therapy (paroxetine and amitriptyline) can be associated with improvement in globus symptoms 25 .…”