Successfull Treatment of Globus Sensation By Argon-Plasma-Coagulation of Gastric Inlet Patches in the Cervical Esophagus - A Pilot Trial

Abstract

Successfull Treatment of Globus Sensation By Argon-Plasma-Coagulation of Gastric Inlet Patches in the Cervical Esophagus A Pilot Trial Alexander Meining, Monther Bajbouj, Martin Preeg, Wolfgang Huber, Heinz Hoefler, Christian Prinz, Roland Schmid Background: It has been mentioned that globus sensation may be caused by gastroesophageal reflux disease. In addition, it has also been suggested, that the presence of a gastric inlet patch can by associated with such symptoms. So far, there are no reports, as to whether ablation of the cervical heterotopic mucosa leads to improvement of chronic globus sensation or other atypical reflux symptoms. Methods: Ten patients with a histologically proven gastric inlet patch and chronic globus sensation and/or sore throat despite therapy with protone-pump inhibitors underwent Argon-plasma-coagulation (APC) of the heterotopic mucosa. Before therapy, a thoroughly examination including barium swallow, laryngoscopy, manometry and 24h-two-channel-pH-metry was performed. A questionnaire was applied for assessment of typical and atypical reflux symptoms based on a visual analogue scale ranging from 0 to 10. Follow-up examinations were performed four and eight weeks after APC-therapy. Results: In all patients, ablation of the gastic inlet patch resulted in a remarkable reduction of symptoms scores for ‘‘globus’’ and/or ‘‘sore throat’’ (median scores for ‘‘globus’’: 2.7 prior and 0.0 eight weeks after therapy; p Z 0.015; median scores for ‘‘sore throat’’: 2.8 prior and 0.0 after therapy; p Z 0.018). Other symptoms assesed such as ‘‘heartburn’’, ‘‘chronic cough’’, ‘‘asthma’’, ‘‘hoarseness’’ or ‘‘burning tongue’’ did not improve significantly after therapy. Data obtained by other examinations in particular pH-metry were not associated with any improvement of symptoms. Conclusion: Our preliminary data suggest that upper endoscopy for screening of gastric inlet patches should be performed in every patient with globus or sore throat sensation. Because of its high effectiveness, APC-treatment might then be considered as the therapy of choice.