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What Is the Available Evidence for the Treatment of Globus Pharyngeus?

  • LARYNGOLOGY: Dysphagia (A Al-Hussaini, Section Editor)
  • Published:
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Abstract

Purpose of Review

Globus pharyngeus is a persistent or intermittent, painless sensation of a foreign body in the throat that represents around 4% of ENT referrals from primary care. The aetiology of this condition is poorly understood and therefore there is no current universally accepted investigation pathway or treatment approach. This review aimed to provide a summary of the established evidence for the treatment of globus pharyngeus. The review used an eight-step, rapid review methodology to create an evidence summary.

Recent Findings

Recent case-control studies have demonstrated positive results in the treatment of globus using selective serotonin reuptake inhibitors and amitriptyline. Positive findings were also seen with the use of proton pump inhibitors, cognitive behavioural therapy and speech and language therapy.

Summary

Despite positive conclusions, strength of evidence is limited by lack of control groups in most studies, short follow-up periods and small study populations. Therefore, there is much room for further research studies and subsequent meta-analysis to move towards an evidence-based treatment algorithm. The authors suggest a case by case approach to the management given the evidence but recommend consideration of speech and language therapy review and potentially cognitive behavioural therapy in intractable cases.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. Ali K, Wilson J. What is the severity of globus sensation in individuals who have never sought health care for it? J Laryngol Otol. 2007;121(9):865–8.

    Article  PubMed  CAS  Google Scholar 

  2. Joiner M, van der Kogel A. Basic clinical radiobiology. 5th ed. Boca Raton: CRC Press; 2018.

    Book  Google Scholar 

  3. Purcell J. A treatise of vapours or hysteric fits. 2nd ed. London: Edward Place; 1707.

    Google Scholar 

  4. Batch A. Globus pharyngeus (Part I). J Laryngol Otol. 1988;102:152–8.

    Article  PubMed  CAS  Google Scholar 

  5. Moloy PJ, Charter R. The globus symptom. Incidence, therapeutic response, and age and sex relationships. Arch Otolaryngol. 1982;108(11):740–4.

    Article  PubMed  CAS  Google Scholar 

  6. Kortequee S, Karkos P, Atkinson H, Sethi N, Sylvester D, Harar R, et al. Management of globus pharyngeus. Int J Otolaryngol. 2013;2013:1–5. https://doi.org/10.1155/2013/946780.

    Article  Google Scholar 

  7. Tang B, Cai HD, Xie HL, Chen DY, Jiang SM, Jia L. Epidemiology of globus symptoms and associated psychological factors in China. J Dig Dis. 2016;17(5):319–24.

    Article  PubMed  Google Scholar 

  8. Chevalier JM, Brossard E, Monnier P. Globus sensation and gastroesophageal reflux. Eur Arch Otorhinolaryngol. 2003;260:273–6.

    PubMed  Google Scholar 

  9. Chen CL, Tsai CC, Chou AS, Chiou JH. Utility of ambulatory pH monitoring and videofluoroscopy for the evaluation of patients with globus pharyngeus. Dysphagia. 2007;22:16–9.

    Article  PubMed  Google Scholar 

  10. Corso MJ, Pursnani KG, Mohiuddin MA, Gideon RM, Castell JA, Katzka DA, et al. Globus sensation is associated with hypertensive upper esophageal sphincter but not with gastroesophageal reflux. Dig Dis Sci. 1998;43:1513–7.

    Article  PubMed  CAS  Google Scholar 

  11. Agada FO, Coatesworth AP, Grace AR. Retroverted epiglottis presenting as a variant of globus pharyngeus. J Laryngol Otol. 2007;121:390–2.

    Article  PubMed  CAS  Google Scholar 

  12. Webb CJ, Makura ZG, Fenton JE, Jackson SR, McCormick MS, Jones AS. Globus pharyngeus: a postal questionnaire survey of UK ENT consultants. Clin Otolaryngol Allied Sci. 2000;25:566–9.

    Article  PubMed  CAS  Google Scholar 

  13. Khangura S, Konnyu K, Cushman R, Grimshaw J, Moher D. Evidence summaries: the evolution of a rapid review approach. Syst Rev. 2012;1:10.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Ryan R, Hill S. How to GRADE the quality of the evidence. In: Cochrane consumer and communication. 2016. Available at http://cccrg.cochrane.org/sites/cccrg.cochrane.org/files/public/uploads/how_to_grade_revising_1_december_2016.pdf. Accessed 2 Jan 2018.

  15. Dumper J, Mechor B, Chau J, Allegretto M. Lansoprazole in globus pharyngeus: double-blind, randomized, placebo-controlled trial. J Otolaryngol Head Neck Surg. 2008;37(5):657–63.

    PubMed  Google Scholar 

  16. Cheng CC, Fang TJ, Lee TJ, Lee LA, Chen TM, Chen CK, et al. Role of flexible transnasal esophagoscopy and patient education in the management of globus pharyngeus. J Formos Med Assoc. 2012;111(3):171–5.

    Article  PubMed  Google Scholar 

  17. Kirch S, Gegg R, Johns MM, Rubin AD. Globus pharyngeus: effectiveness of treatment with proton pump inhibitors and gabapentin. Ann Otol Rhinol Laryngol. 2013;122(8):492–5.

    Article  PubMed  Google Scholar 

  18. Nakano S, Iwasaki H, Kondo E, Miyazaki K, Shizuku H, Kamimura S, et al. Efficacy of proton pump inhibitor in combination with rikkunshito in patients complaining of globus pharyngeus. J Med Investig. 2016;63(3–4):227–9.

    Article  Google Scholar 

  19. Millichap F, Lee M, Pring T. A lump in the throat: should speech and language therapists treat globus pharyngeus? Disabil Rehabil. 2005;27:124–30.

    Article  PubMed  CAS  Google Scholar 

  20. Khalil HS, Reddy VM, Bos-Clark M, Dowley A, Pierce MH, Morris CP, et al. Speech therapy in the treatment of globus pharyngeus: how we do it. Clin Otolaryngol. 2011;36(4):388–92.

    Article  PubMed  CAS  Google Scholar 

  21. Bishop LC, Riley WT. The psychiatric management of the globus syndrome. Gen Hosp Psychiatry. 1988 May;10(3):214–9.

    Article  PubMed  CAS  Google Scholar 

  22. Donohue B, Thevenin DM, Runyon MK. Behavioral treatment of conversion disorder in adolescence. A case example of globus hystericus. Behav Modif. 1997;21(2):231–51.

    Article  PubMed  CAS  Google Scholar 

  23. Motoo Y, Taga H, Su SB, Sawabu N. Effect of Koso-san on globus pharyngeus. Am J Chin Med. 1999;27(2):283–8.

    Article  PubMed  CAS  Google Scholar 

  24. Finkenbine R, Miele VJ. Globus hystericus: a brief review. Gen Hosp Psychiatry. 2004;26(1):78–82.

    Article  PubMed  Google Scholar 

  25. You LQ, Liu J, Jia L, Jiang SM, Wang GQ. Effect of low-dose amitriptyline on globus pharyngeus and its side effects. World J Gastroenterol. 2013;19(42):7455–60.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  26. • Chen DY, Jia L, Gu X, Jiang SM, Xie HL, Xu J. Comparison of paroxetine and amitriptyline in the treatment of refractory globus pharyngeus. Dig Liver Dis. 2016;48(9):1012–7. This study used randomised control trial methodology and subjective outcome measures to compare the effects of paroxetine, amitriptyline and lansoprazole.

    Article  PubMed  CAS  Google Scholar 

  27. • Zhou WC, Jia L, Chen DY, Liu Y, Liu J, Jiang SM, et al. The effects of paroxetine and amitriptyline on the upper esophageal sphincter (UES) pressure and its natural history in globus pharyngeus. Dig Liver Dis. 2017;49(7):757–63. This study used upper oesophageal pressure measurements and subjective symptom assessment to quantify the effects of paroxetine, amitriptyline and lansoprazole.

    Article  PubMed  CAS  Google Scholar 

  28. Agada FO, Coatesworth AP, Grace AR. Retroverted epiglottis presenting as a variant of globus pharyngeus. J Laryngol Otol. 2007;121:390–2.

    Article  PubMed  CAS  Google Scholar 

  29. Burns P, O’Neill JP. The diagnosis and management of globus: a perspective from Ireland. Curr Opin Otolaryngol Head Neck Surg. 2008;16:503–6.

    Article  PubMed  Google Scholar 

  30. Khalil HS. The diagnosis and management of globus: a perspective from the United Kingdom. Curr Opin Otolaryngol Head Neck Surg. 2008;16(6):516–20.

    Article  PubMed  Google Scholar 

  31. Karkos PD, Wilson JA. The diagnosis and management of globus pharyngeus: our perspective from the United Kingdom. Curr Opin Otolaryngol Head Neck Surg. 2008;16:521–4.

    Article  PubMed  Google Scholar 

  32. Lee BE, Kim GH. Globus pharyngeus: a review of its etiology, diagnosis and treatment. World J Gastroenterol. 2012;18(20):2462–71.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Schindler A, Mozzanica F, Alfonsi E, Ginocchio D, Rieder E, Lenglinger J, et al. Upper esophageal sphincter dysfunction: diverticula-globus pharyngeus. Ann N Y Acad Sci. 2013;1300:250–60.

    Article  PubMed  Google Scholar 

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Correspondence to J. Heyman.

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The authors declare that they have no competing interests.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on LARYNGOLOGY: Dysphagia

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Heyman, J., Owens, D. What Is the Available Evidence for the Treatment of Globus Pharyngeus?. Curr Otorhinolaryngol Rep 6, 189–195 (2018). https://doi.org/10.1007/s40136-018-0197-1

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  • DOI: https://doi.org/10.1007/s40136-018-0197-1

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