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

Abstract

"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.

Predictive value of globus pharyngeus in patients with functional dysphonia versus organic dysphonia

“…After excluding the aforementioned confounders, patients are started on neuromodulators with promising results . Other suggested etiologies of functional dysphonia are psychological disorders, namely conversion disorders, anxiety, and depression, all of which have been implicated in patients with globus sensation . Anxiety and depression are considered as predisposing and confounding diseases for globus .…”

“…13 Other suggested etiologies of functional dysphonia are psychological disorders, namely conversion disorders, anxiety, and depression, all of which have been implicated in patients with globus sensation. 8,32,34 Anxiety and depression are considered as predisposing and confounding diseases for globus. 26,[35][36][37] Stress has been reported as a pathogenic factor in 96% of patients with globus sensation, with exacerbation of their symptoms during periods of high emotional intensity.…”

“…The association between globus and dysphonia has always been reported in the context of esophageal motility dysfunction, laryngopharyngeal reflux disease (LPRD), laryngeal sensory neuropathy muscle tension dysphagia, and in the context of allergy . In the context of esophageal dysfunction, Moser et al described abnormal esophageal manometry in 67% of patients with globus, and Manabe et al have attributed ineffective esophageal motility in affected patients to achalasia, esophageal spasm, and abnormal lower esophageal function . Extraesophageal reflux is also believed to be one of the main factors contributing to the pathogenesis of globus pharyngeus .…”

“…6 Although the natural history of globus is yet to be fully established, almost 45% of patients continue to have persistent symptoms at their 7-year follow-up. 7 The association between globus and dysphonia has always been reported in the context of esophageal motility dysfunction, 8 laryngopharyngeal reflux disease (LPRD), [9][10][11][12] laryngeal sensory neuropathy 11,13 muscle tension dysphagia, 14 and in the context of allergy. 15 In the context of esophageal dysfunction, Moser et al described abnormal esophageal manometry in 67% of patients with globus, and Manabe et al have attributed ineffective esophageal motility in affected patients to achalasia, esophageal spasm, and abnormal lower esophageal function.…”

“…15 In the context of esophageal dysfunction, Moser et al described abnormal esophageal manometry in 67% of patients with globus, and Manabe et al have attributed ineffective esophageal motility in affected patients to achalasia, esophageal spasm, and abnormal lower esophageal function. 8,16 Extraesophageal reflux is also believed to be one of the main factors contributing to the pathogenesis of globus pharyngeus. 17,18 Hoon Park et al reported LPRD in 71.9% of patients complaining of globus with no organic cause.…”