GLOBUS-PHARYNGIS, COMMONLY ASSOCIATED WITH ESOPHAGEAL MOTILITY DISORDERS

Objectives: To evaluate the role of gastrointestinal and psychiatric e tiology in globus sensation. Methods: The study population consisted o f 32 consecutive patients with globus sensation without dysphagia refe rred to the Department of Otorhinolaryngology in Helsinki University H ospital. Eleven patients were excluded from the study: two because of advanced age, one prisoner, and six patients refused further studies. Only two patients (6%) were found to have abnormal otorhinolaryngologi cal status. These patients were also excluded from the study. Esophago gastroduodenoscopy, 24-h pH recording, esophageal manometry, and Berns tein acid perfusion test were carried out in 21 patients (13 females, eight males, mean age 49 yr). Psychiatric evaluation was done in 20 pa tients; one patient refused the psychiatric consultation. Results: Abn ormal endoscopy was found in 12/21 (57%) of the patients, with antral gastritis and hiatal hernia being the most common findings. Two patien ts had esophagitis. Sixty-seven percent demonstrated abnormalities in esophageal manometry, the most frequent finding being a nonspecific es ophageal motility disorder (29%). pH monitoring was normal in 16/21 of patients (76%), whereas the Bernstein test showed positive results in 13/21 (62%). With DSM IIIR as the diagnostic tool, five of 20 patient s (25%) received a psychiatric diagnosis. Conclusions: Globus sensatio n has a multiple etiology, and local reasons are rare but should first be ruled out. Abnormalities in esophageal motility are commonly found , and these patients seem to be sensitive to esophageal acidity. Esoph ageal manometry and ambulatory 24-h pH recording should be included in the evaluation of a globus patient. The number of psychiatric disorde rs does not differ from that in the general population. Treatment of g lobus sensation should be directed toward the abnormality found behind the symptom.