GLOBUS SENSATION IS ASSOCIATED WITH HYPERTENSIVE UPPER ESOPHAGEAL SPHINCTER BUT NOT WITH GASTROESOPHAGEAL REFLUX

Globus sensation (globus) is best described as a constant feeling of a lump or fullness in the throat. Although the etiology of globus remai ns unclear, it has been attributed to a hypertensive upper esophageal sphincter (UES) resting pressure and to gastroesophageal reflux (GER). The aim of this study was, therefore, to determine if significant ass ociations existed among globus, UES resting pressure, and GER. We revi ewed the records of all patients who had stationary esophageal manomet ry over a 2 1/2-year interval with specific attention to symptoms of g lobus, UES pressures, and ambulatory pH studies. Patients with hypoten sive UES (<30 mm Hg) were excluded. Chi square (chi(2)) test was used to determine significant associations. Six hundred fifty patients had normal UES resting pressures and 101 patients had hypertensive UES (>1 18 mm Hg). Seventeen of the 650 (3%) (16 women/1 man; mean age: 48, ra nge 32-81 years) with normal UES described globus. Conversely, 28 of t he 101 (28%) (15 women/13 men; mean age: 43, range 23-61 years) patien ts with hypertensive UES described globus. There was a significant ass ociation between hypertonicity of the UES and globus (chi(2) = 93.42, P < 0.0001). In patients with normal UES, globus occurred predominantl y in females (chi(2) = 6.33, P < 0.01). Twenty-three (16 women/7 men; mean age: 43, range 23-60 years) of the 45 patients with globus had pr ior ambulatory pH studies. Six of 23 (26%) had GER. Compared to an age -, sex-, and UES-pressure-matched group of 23 patients (16 women/7 men ; mean age: 44, range 22-75 years) without globus, nine (39%) had GER, thus showing no significant association of globus with GER (P = 0.35) . There also was no significant association of GER with normal UES or with hypertensive UES in these patients. In conclusion, there is a sig nificant association between hypertensive UES and globus. The data sug gest two possible etiologies: female patients with normal UES pressure potentially having increased afferent sensation and a group with equa l sex distribution but abnormally elevated UES resting pressure. This study does not support GER as an etiology of globus.