Abstract
BackgroundGlobus pharyngeus is common and has a low cure rate. Its etiology is complex and reported to be associated with laryngopharyngeal reflux (LPR). However, some patients with globus do not exhibit any reflux symptoms or respond to proton pump inhibitors (PPIs) treatments. The purpose of this study was to clarify the related risk factors of these patients with a final objective of improving the curative effect.MethodsForty two patients afflicted with globus pharyngeus (G group) and 38 patients without globus pharyngeus (NG group) were included in this study. According to the laryngopharyngeal Reflux Symptom Index and the response to PPIs treatments, the patients were further divided into reflux groups (G-R, NG-R) and non-reflux groups (G-NR, NG-NR). High Resolution Manometry (HRM) was performed to assess esophageal motility. Questionnaires, including categories such as life exposure factors, were conducted.Resultsa) The average resting and residual pressures of the upper esophageal sphincter (UES) in the G-NR group was higher than in the NG-NR and NG-R groups (P < 0.05). b) The average resting and residual pressures of the lower esophageal sphincter showed no differences between the G-NR group and the NG-NR group (P > 0.05). c) The esophageal distal contractile integral score of the G-NR group was not different from the NG-NR group (P > 0.05). d) Compared to the NG-NR group, the G-NR group showed higher incidence of stress, smoking, drinking, high salt and anxiety (P < 0.05).ConclusionsGlobus pharyngeus without LPR may occur due to high UES pressure. Stress, smoking, alcoholic drinking, high salt and anxiety may be its risk factors.
Highlights
Globus pharyngeus is common and has a low cure rate
In 1989, they once again used the similar methods to monitor pH over 24 h in 32 patients with globus pharyngeus. This time they reported that the symptoms and the acid reflux times of these patients were all different from gastroesophageal reflux disease (GERD), and esophagitis was hardly found
Similar differences were noted in the residual upper esophageal sphincter (UES) pressure among the groups: the average residual pressure of the UES in the G group was higher than that in the NG group (Fig. 2c); the average residual UES pressure in the GNR group was higher than that in the NG-R and NG-NR groups (P < 0.05), but lower than that in the G-R group (P < 0.05) (Fig. 2d)
Summary
Globus pharyngeus is common and has a low cure rate. Its etiology is complex and reported to be associated with laryngopharyngeal reflux (LPR). Wiener et al placed probes into the esophagus and on the top of the upper esophageal sphincter (UES) to detect pH over a course of 24 h using doubleprobe pH testing They found that patients with globus pharyngeus had laryngopharyngeal acid reflux. In 1989, they once again used the similar methods to monitor pH over 24 h in 32 patients with globus pharyngeus This time they reported that the symptoms and the acid reflux times of these patients were all different from gastroesophageal reflux disease (GERD), and esophagitis was hardly found. One study showed that abnormal laryngopharyngeal or esophageal reflux was not indicated by pH-impedance monitoring in some patients with suspected LPR refractory to proton pump inhibitors (PPIs) treatments. This study was performed to clarify the related factors of the symptoms of globus pharyngeus refractory to PPIs treatments and to learn more about G-NR so as to improve the curative effect
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