Managing a patient with globus pharyngeus

Abstract

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.

Major Depressive Disorder in the Older Adult Associated With Globus Pharyngeus and Weight Loss – An Indication for Electroconvulsive Therapy

“…3 GP is reported by >10% in population-based studies in the US. 4 GP is most often seen in middle-aged women, and is less common in older adults. 5−7 Symptoms usually persist for an average of 6 months.…”

“…3 Weight loss is uncommon in GP, and weight gain may be observed as the patient attempts to overcome the globus sensation by eating more. 4 Extreme weight loss is the exception, and is accompanied by depression. 11 Death has not been reported to result directly from GP, 6 and the medical literature typically states that GP is harmless, 8 or GP can be mild and self-limiting, 3 with "no long-term health consequences."…”

“…11 Death has not been reported to result directly from GP, 6 and the medical literature typically states that GP is harmless, 8 or GP can be mild and self-limiting, 3 with "no long-term health consequences." 4 In some cases, GP is a "functional" disorder characterized by a patient's insistence that swallowing liquids or foods is difficult if not impossible despite the absence of verifiable anatomic or physiologic disease in swallowing.…”

Multiple symptoms, multiple systems

“…This edition of Frontline Gastroenterology has two papers that address this patient cohort. An algorithmic approach to managing globus is proposed by Harvey, Theron and Trudgill 4. The place for double dose PPI versus consideration of psychological therapy is placed in the context of when a patient may benefit from an upper GI endoscopy or oesophageal physiology studies.…”

Angiomyomatous hamartoma of subglottic tracheal wall in a 12-year-old adolescent: a case report

“…However, a description of an intermittent sensation of a flap in the throat presents a diagnostic challenge. Often described as a lump lodged in the throat, the differential diagnosis may include a globus pharyngeus or globus sensation of the throat [ 2 , 3 ]. Similarly, vocal cord dysfunction (VCD) or paradoxical vocal fold movement (PVFM), might be stress- or anxiety-induced, and may also present with clinical features of asthma [ 4 ].…”