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Dysphagia

, Volume 4, Issue 1, pp 35–38 | Cite as

Psychogenic dysphagia and globus: Reevaluation of 23 patients

  • William J. Ravich
  • Ron S. Wilson
  • Bronwyn Jones
  • Martin W. Donner
Article

Abstract

Despite warnings against attributing dysphagia to psychological causes, the diagnoses of “psychogenic dysphagia” or “globus hystericus” have been previously applied to 13% of patients referred to the Johns Hopkins Swallowing Center. This paper reports the results of reevaluation of 23 patients previously diagnosed as having symptoms of psychogenic origin. The Swallowing Center evaluation documented an explanation for symptoms in 15 (65%). No cause of dysphagia could be documented in eight patients. All five patients with the “globus sensation” had a documentable abnormality of swallowing. Overall, nine patients had esophageal pathology, while six had pharyngeal disease. Five had structural lesions constricting the lumen, while 10 had motor dysfunction of either the pharynx or esophagus. Review of the referral records of these patients indicates the quality of prior evaluation for patients previously labeled as having a swallowing disorder of psychogenic origin is variable, and that once attribution of symptoms to psychogenic causes is made, the diagnosis is rarely reconsidered. We conclude that attribution of the diagnosis of psychogenic dysphagia should be made with caution, and only after thorough evaluation. Any change or progression of symptoms should prompt a careful re-evaluation.

Key words

Psychogenic, globus 

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References

  1. 1.
    Hendrix TR: Dysphagia. In Thorn GW, Adams RD, Braunwald E et al. (eds):Harrison's Principles of Internal Medicine, (8th ed.). New York: McGraw-Hill, pp. 203–205, 1977Google Scholar
  2. 2.
    Pope CE: 1982. Diseases of the esophagus. In Wyngaarden JB, Smith LH (eds)Cecil Textbook of Medicine, (16th ed.). Philadelphia: WB Saunders, pp 621–632, 1982Google Scholar
  3. 3.
    Peura DA, Johnson LF: Esophageal Stricture. In Bayless TM (ed):Current Therapy in Gastroenterology and Liver Disease, 2. Toronto: B.C. Decker Inc., pp 25–29, 1986Google Scholar
  4. 4.
    Pratt LW, Tobin WH, Gallagher R: Globus hystericus — office evaluation by psychological testing with the MMPI.Laryngoscope 86:1540–1551, 1976PubMedGoogle Scholar
  5. 5.
    Puhakka H, Lehtenen V, Aalto T: Globus hystericus — a psychosomatic disease?J Laryngol Otol 90:1021–1026, 1976PubMedGoogle Scholar
  6. 6.
    Flores TC, Cross FS, Jones RD: Abnormal esophageal manometry in globus hystericus.Ann Otol Rhinol Laryngol 90:383–386, 1981PubMedGoogle Scholar
  7. 7.
    Watson WC, Sullivan SN: Hypertonicity of the cricopharyngeal sphincter: a cause of globus sensation.Lancet 2:1417–1419, 1974CrossRefPubMedGoogle Scholar
  8. 8.
    Cherry J, Siegel CI, Margulies SI, Donner MW: Pharyngeal localization of gastroesophageal reflux.Ann Otol 79:912–916, 1970Google Scholar
  9. 9.
    Freeland AP, Ardran GM, Embrys-Roberts E: Globus hystericus and reflux oesophagitis.J Laryngol Otol 88:1025–1031, 1974PubMedGoogle Scholar
  10. 10.
    Weisskopf A: Reflux esophagitis: a cause of globus.Otolaryngol Head Neck Surg 89:780–782, 1981PubMedGoogle Scholar
  11. 11.
    Delahunty JE, Ardran GM: Globus hystericus — a manifestation of reflux oesophagitis?J Laryngol Otol 84:1049–1054, 1970PubMedGoogle Scholar
  12. 12.
    Thompson WG, Heaton KW: Heartburn and globus in apparently healthy people.Can Med Assoc J 126:46–48, 1982PubMedGoogle Scholar
  13. 13.
    Moloy PJ, Charter R: The globus symptom: incidence, therapeutic response, and age and sex relationships.Arch Otolarnygol 108:740–744, 1982Google Scholar

Copyright information

© Springer-Verlag New York Inc. 1989

Authors and Affiliations

  • William J. Ravich
    • 1
    • 2
  • Ron S. Wilson
    • 1
    • 2
  • Bronwyn Jones
    • 1
    • 3
  • Martin W. Donner
    • 1
    • 3
  1. 1.Johns Hopkins Swallowing CenterThe Johns Hopkins School of MedicineBaltimoreUSA
  2. 2.The Meyerhoff Center for Digestive Disease of the Division of GastroenterologyThe Johns Hopkins School of MedicineBaltimoreUSA
  3. 3.The Russell H. Morgan Department of Radiology and Radiologic ScienceThe Johns Hopkins School of MedicineBaltimoreUSA

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