Transition zone defect associated with the response to proton pump inhibitor treatment in patients with globus sensation

Abstract

Few data describing short-term proton pump inhibitor (PPI) treatment in patients with globus sensation exist. The aim of this study was to evaluate the use of high-resolution manometry (HRM) for predicting the response to PPI treatment in patients with globus sensation. A total of 41 patients with globus sensation were treated with PPIs for 4 weeks and were classified as positive and negative responders. HRM topographical plots were analyzed for relevant manometric parameters. In addition, clinical and HRM data of 20 patients with typical gastroesophageal reflux disease (GERD) not presenting globus symptom were analyzed. Of the 41 patients, 19 (46%) were clinically diagnosed with GERD. The proportion of patients with favorable symptomatic improvement was higher in patients with GERD than in those without reflux (P=0.046). Positive and negative responders to PPI treatment did not differ in upper esophageal sphincter and proximal esophageal contraction. In globus patients with GERD, the temporal and spatial dimension of the transitional zone were greater among negative responders than among PPI-positive responders (P=0.010 and P=0.011). Regarding GERD patients without globus, there was no significant difference in transition zone defect according to PPI responsiveness. By receiver operating characteristic curve analysis, 2.1 cm and 1.1 s were found to be the spatial and temporal transitional zone dimensions that best differentiated positive and negative responders. In patients with GERD-related globus, there were larger transition zone defect in the negative responders compared with the PPI-positive responders.