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Globus sensation

Kristen M Robson, MD, MBA, FACG
Anthony J Lembo, MD
Section Editor
Nicholas J Talley, MD, PhD
Deputy Editor
Shilpa Grover, MD, MPH, AGAF


Globus sensation is a functional esophageal disorder characterized by a sensation of a lump or foreign body in the throat. Globus sensation has also been referred to as globus pharyngeus and the misnomer "globus hystericus." This topic will review the epidemiology, etiology, diagnosis, and management of patients with globus sensation. The evaluation of oropharyngeal and esophageal dysphagia are discussed in detail, separately. (See "Approach to the evaluation of dysphagia in adults" and "Oropharyngeal dysphagia: Clinical features, diagnosis, and management".)


Globus sensation is a functional esophageal disorder characterized by a sensation of a lump, retained food bolus, or tightness in the throat that is not due to an underlying structural lesion, gastroesophageal reflux disease, mucosal abnormality, or an esophageal motility disorder [1].


A sensation of a lump or foreign body in the throat is common in the general population, as illustrated in one study in which 45 percent of 147 healthy volunteers had experienced it at least once [2]. It accounts for 4 percent of visits to otolaryngology clinics [3]. The symptom is equally prevalent in men and women among healthy individuals in the community, but women are more likely to seek evaluation. In primary care, one study reported the prevalence amongst consulters to be 6.7 per 100,000 practice encounters [4].


The pathogenesis of globus sensation is unclear. Visceral hypersensitivity, abnormalities of the upper esophageal sphincter (UES), psychologic and psychiatric disorders, and reflux have all been implicated.

Visceral hypersensitivity — Hypersensitivity to balloon distention is a common feature in patients with globus sensation. In one study, nine patients with globus were found to be hypersensitive to balloon distention but not electrical stimulation of the esophagus as compared with healthy controls [5]. In addition, the majority of patients with globus and none of the healthy controls referred the sensation during balloon distention to the suprasternal notch, suggesting that patients with globus may have aberrant central processing of esophageal sensations.

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Literature review current through: Oct 2017. | This topic last updated: May 17, 2016.
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  1. Aziz Q, Fass R, Gyawali CP, et al. Functional Esophageal Disorders. Gastroenterology 2016.
  2. Thompson WG, Heaton KW. Heartburn and globus in apparently healthy people. Can Med Assoc J 1982; 126:46.
  3. Moloy PJ, Charter R. The globus symptom. Incidence, therapeutic response, and age and sex relationships. Arch Otolaryngol 1982; 108:740.
  4. Pollack A, Charles J, Harrison C, Britt H. Globus hystericus. Aust Fam Physician 2013; 42:683.
  5. Chen CL, Szczesniak MM, Cook IJ. Evidence for oesophageal visceral hypersensitivity and aberrant symptom referral in patients with globus. Neurogastroenterol Motil 2009; 21:1142.
  6. Corso MJ, Pursnani KG, Mohiuddin MA, et al. Globus sensation is associated with hypertensive upper esophageal sphincter but not with gastroesophageal reflux. Dig Dis Sci 1998; 43:1513.
  7. Kwiatek MA, Mirza F, Kahrilas PJ, Pandolfino JE. Hyperdynamic upper esophageal sphincter pressure: a manometric observation in patients reporting globus sensation. Am J Gastroenterol 2009; 104:289.
  8. Caldarelli DD, Andrews AH Jr, Derbyshire AJ. Esophageal motility studies in globus sensation. Ann Otol Rhinol Laryngol 1970; 79:1098.
  9. Cook IJ, Dent J, Collins SM. Upper esophageal sphincter tone and reactivity to stress in patients with a history of globus sensation. Dig Dis Sci 1989; 34:672.
  10. Wilson JA, Pryde A, Piris J, et al. Pharyngoesophageal dysmotility in globus sensation. Arch Otolaryngol Head Neck Surg 1989; 115:1086.
  11. Deary IJ, Smart A, Wilson JA. Depression and 'hassles' in globus pharyngis. Br J Psychiatry 1992; 161:115.
  12. Wilson JA, Deary IJ, Maran AG. Is globus hystericus? Br J Psychiatry 1988; 153:335.
  13. Deary IJ, Wilson JA, Mitchell L, Marshall T. Covert psychiatric disturbance in patients with globus pharyngis. Br J Med Psychol 1989; 62 ( Pt 4):381.
  14. Wilson JA, Deary IJ, Mardon SL. Globus (letter). Lancet 1989; 1:780.
  15. Bradley PJ, Narula A. Clinical aspects of pseudodysphagia. J Laryngol Otol 1987; 101:689.
  16. Vakil NB, Kahrilas PJ, Dodds WJ, Vanagunas A. Absence of an upper esophageal sphincter response to acid reflux. Am J Gastroenterol 1989; 84:606.
  17. Woo P, Noordzij P, Ross JA. Association of esophageal reflux and globus symptom: comparison of laryngoscopy and 24-hour pH manometry. Otolaryngol Head Neck Surg 1996; 115:502.
  18. Hill J, Stuart RC, Fung HK, et al. Gastroesophageal reflux, motility disorders, and psychological profiles in the etiology of globus pharyngis. Laryngoscope 1997; 107:1373.
  19. Locke GR 3rd, Talley NJ, Fett SL, et al. Prevalence and clinical spectrum of gastroesophageal reflux: a population-based study in Olmsted County, Minnesota. Gastroenterology 1997; 112:1448.
  20. Anandasabapathy S, Jaffin BW. Multichannel intraluminal impedance in the evaluation of patients with persistent globus on proton pump inhibitor therapy. Ann Otol Rhinol Laryngol 2006; 115:563.
  21. Wilson JA, Heading RC, Maran AG, et al. Globus sensation is not due to gastro-oesophageal reflux. Clin Otolaryngol Allied Sci 1987; 12:271.
  22. Färkkilä MA, Ertama L, Katila H, et al. Globus pharyngis, commonly associated with esophageal motility disorders. Am J Gastroenterol 1994; 89:503.
  23. Moser G, Wenzel-Abatzi TA, Stelzeneder M, et al. Globus sensation: pharyngoesophageal function, psychometric and psychiatric findings, and follow-up in 88 patients. Arch Intern Med 1998; 158:1365.
  24. Takwoingi YM, Kale US, Morgan DW. Rigid endoscopy in globus pharyngeus: how valuable is it? J Laryngol Otol 2006; 120:42.
  25. Hajioff D, Lowe D. The diagnostic value of barium swallow in globus syndrome. Int J Clin Pract 2004; 58:86.
  26. Harar RP, Kumar S, Saeed MA, Gatland DJ. Management of globus pharyngeus: review of 699 cases. J Laryngol Otol 2004; 118:522.
  27. Caylakli F, Yavuz H, Erkan AN, et al. Evaluation of patients with globus pharyngeus with barium swallow pharyngoesophagography. Laryngoscope 2006; 116:37.
  28. Alhilali L, Seo SH, Branstetter BF 4th, Fakhran S. Yield of neck CT and barium esophagram in patients with globus sensation. AJNR Am J Neuroradiol 2014; 35:386.
  29. Marshall JN, McGann G, Cook JA, Taub N. A prospective controlled study of high-resolution thyroid ultrasound in patients with globus pharyngeus. Clin Otolaryngol Allied Sci 1996; 21:228.
  30. Hori K, Kim Y, Sakurai J, et al. Non-erosive reflux disease rather than cervical inlet patch involves globus. J Gastroenterol 2010; 45:1138.
  31. Sinn DH, Kim JH, Kim S, et al. Response rate and predictors of response in a short-term empirical trial of high-dose rabeprazole in patients with globus. Aliment Pharmacol Ther 2008; 27:1275.
  32. Weijenborg PW, de Schepper HS, Smout AJ, Bredenoord AJ. Effects of antidepressants in patients with functional esophageal disorders or gastroesophageal reflux disease: a systematic review. Clin Gastroenterol Hepatol 2015; 13:251.
  33. Cybulska EM. Globus hystericus--a somatic symptom of depression? The role of electroconvulsive therapy and antidepressants. Psychosom Med 1997; 59:67.
  34. Brown SR, Schwartz JM, Summergrad P, Jenike MA. Globus hystericus syndrome responsive to antidepressants. Am J Psychiatry 1986; 143:917.
  35. You LQ, Liu J, Jia L, et al. Effect of low-dose amitriptyline on globus pharyngeus and its side effects. World J Gastroenterol 2013; 19:7455.
  36. Cybulska EM. Globus hystericus or depressivus? Hosp Med 1998; 59:640.
  37. Kirch S, Gegg R, Johns MM, Rubin AD. Globus pharyngeus: effectiveness of treatment with proton pump inhibitors and gabapentin. Ann Otol Rhinol Laryngol 2013; 122:492.
  38. Kiebles JL, Kwiatek MA, Pandolfino JE, et al. Do patients with globus sensation respond to hypnotically assisted relaxation therapy? A case series report. Dis Esophagus 2010; 23:545.
  39. Timon C, O'Dwyer T, Cagney D, Walsh M. Globus pharyngeus: long-term follow-up and prognostic factors. Ann Otol Rhinol Laryngol 1991; 100:351.