- Kristen M Robson, MD, MBA, FACG
Kristen M Robson, MD, MBA, FACG
- Assistant Professor
- Tufts University School of Medicine
- Anthony J Lembo, MD
Anthony J Lembo, MD
- Associate Professor of Medicine
- Harvard Medical School
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 "Overview 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 .
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 . It accounts for 4 percent of visits to otolaryngology clinics . 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 .
ETIOLOGY AND PATHOGENESIS
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 . 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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- ETIOLOGY AND PATHOGENESIS
- Visceral hypersensitivity
- Upper esophageal sphincter dysfunction
- Psychologic abnormalities
- Gastroesophageal reflux
- CLINICAL MANIFESTATIONS
- Diagnostic approach
- History and physical examination
- Additional evaluation
- - Nasoendoscopy
- - Videofluoroscopy
- - Imaging
- - Esophageal manometry
- - Esophageal pH and impedance
- Upper endoscopy
- DIFFERENTIAL DIAGNOSIS
- Initial management
- - Conservative therapy
- - Acid suppression
- Subsequent management
- - Antidepressants
- - Other
- SUMMARY AND RECOMMENDATIONS