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Globus Pharyngeus

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Principles of Deglutition

Abstract

Globus is an extremely common, benign condition in the community. Surprisingly little is known about its aetiology. While reflux disease can be a contributory factor in a proportion of patients, there is no high level evidence that reflux causes globus. Controlled, carefully conducted radiological and manometric studies have failed to demonstrate consistent underlying motor dysfunction of the pharynx, cricopharyngeus or oesophagus. Oscillatory, inspiration-related augmentation in upper oesophageal sphincter pressure has been demonstrated but the pathogenetic relevance of this finding is unclear. Oesophageal hypersensitivity and aberrant viscerosomatic referral of oesophageal sensation to the neck has been demonstrated suggesting upregulation of oesophageal visceral afferents might be implicated. Clinical assessment in cases where globus is the sole symptom and in which there are no “alarm” symptoms (dysphagia, weight loss, pain, hoarseness), could be confined to nasolaryngoscopic examination of the larynx and pharynx. While current guidelines recommend a trial of PPI therapy in globus, there is no high level evidence to support this recommendation. A randomised controlled study has shown APC ablation of cervical oesophageal inlet patch mucosa, when present, can alleviate globus. Adoption of such therapy, however, must balance the risk of potential complications with a very common benign sensory symptom.

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  1. Department of Gastroenterology and Hepatology, St George Hospital, Kogarah, NSW, 2217, Australia

    Ian J. Cook MBBS, MD(Syd), FRACP

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  1. Ian J. Cook MBBS, MD(Syd), FRACP
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Correspondence to Ian J. Cook MBBS, MD(Syd), FRACP .

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Editors and Affiliations

  1. Div. Gastroenterology & Hepatology, Medical College of Wisconsin, West Wisconsin Avenue 9200, Milwaukee, 53226, Wisconsin, USA

    Reza Shaker

  2. , Dpt Otolaryngology/Head & Neck Surg., UC Davis Medical Center, Stockton Blvd. 2521, Sacramento, 95817, California, USA

    Peter C. Belafsky

  3. Ctr for Voice, Airway & Swallowing Disor, Department of Otolaryngology, Georgia Health Sciences University, 15th Street 1120, Augusta, 30912, Georgia, USA

    Gregory N. Postma

  4. , Dpt of Communication Sciences & Disorder, University of Wisconsin-Milwaukee, East Hartford Ave 2400, Milwaukee, 53201, Wisconsin, USA

    Caryn Easterling

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Cook, I.J. (2013). Globus Pharyngeus. In: Shaker, R., Belafsky, P., Postma, G., Easterling, C. (eds) Principles of Deglutition. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-3794-9_32

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