Gastroesophageal Reflux Disease in Patients with Globus Pharyngeus - A Preliminary Report

Abstract

BACKGROUND: Besides emotional stress, gastroesophageal reflux disease (GERD) has been shown to play a significant role in the pathogenesis of globus pharyngeus, especially in western populations where the prevalence of GERD is high. GERD is less prevalent in Taiwan than in western countries, and its significance in Taiwanese patients with globus pharyngeus in unknown. This study investigated the relation between globus pharyngeus and GERD in a cohort of Taiwanese patients. METHODS: Patients who had globus pharyngeus for more than half a year were candidates for further evaluations, including a questionnaire for pertinent clinical information, flexible videolaryngoscopy, manometry, 24-hour pH monitoring, and psychiatric evaluation. RESLUTS: From October 1998, to March 1999, a total of 7 patients with globus pharyngeus underwent the aforementioned evaluations. Evidence of GERD by pH monitoring was found in only one out of seven patients, while sleep or psychiatric disturbances were found in six out of seven patients. Evidence of GERD was found in one of the two patients with typical GERD symptoms, and was not found in the five patients with no typical GERD symptoms. Laryngoscopy and manometry showed either normal or nonspecific findings in all patients. CONCLUSIONS: In this preliminary study based on 7 patients, the proportion of the globus pharyngeus patients with GERD was approximately 14%, which is which is lower than has been reported from western populations (58% and 64%). It suggests that GERD might play a less significant role in the pathogenesis of globus pharyngeus in Taiwanese than in western patients. Eighty-six percent of our patients have either sleep or psychiatric disturbance suggests emotional stress as the most important etiologic factor for globus pharyngeus. For Taiwanese patients with globus phayrngeus, inquiry of the presence of typical GERD symptoms (acid regurgitation and heartburn) might be a useful screening method for those patients who shall receive further evaluations to rule out GERD. However, because of the small case number in the present study, further study with more patients included is needed to support this point of view.