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Query: UMLS:C0017168 (gastroesophageal reflux disease)
 11,783 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Globus pharyngeus and post-nasal drip are common patient complaints encountered in general otolaryngologic practice. Although these complaints have been traditionally ascribed to stress and sinusitis respectively, recently it has been suggested that they are secondary to gastroesophageal reflux, either by a direct effect on the pharynx and posterior larynx or by referred sensation along vagal pathways from the lower esophagus. This reflux could alter the motor tone of the laryngoesophagus and contribute to the pathogenesis of dysphonias. If globus and post-nasal drip are secondary to gastroesophageal reflux, then reduction of stomach pH should reduce the frequency and severity of these complaints. To test these hypotheses in a clinical setting, a large population of patients with vocal disorders was analyzed for the incidence of these complaints. Twenty healthy patients with globus and/or postnasal drip were then entered in a double-blind random placebo-controlled study to assay the efficacy of cimetidine in treating these complaints. No significant difference was found between cimetidine and placebo.
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PMID:A double-blind controlled study of the efficacy of cimetidine in the treatment of the cervical symptoms of gastroesophageal reflux. 219 5

Globus is an ill-defined entity. Patients present with a variety of diffuse, imprecise symptoms related to the pharynx. A complete investigation with radiological and manometric studies will put in evidence, in most cases, a gastro-esophageal reflux. The anti-reflux treatment is usually successful. The authors insist here on the various pathophysiological mechanisms.
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PMID:[Pharyngeal paraesthesis secondary and gastro-esophageal reflux]. 662 Apr 53

The globus symptom was found to be the seventh most common initial complaint (4.1%) among 4,330 consecutive first-visit patients to a general otolaryngology clinic. Globus is a well-defined clinical symptom that is persistent, difficult to treat, and has a tendency to recur. The incidence is fairly constant among men. Relative to men, women are affected three times more commonly at 50 years of age and below and with equal frequency above 50 years. No seasonal variation in incidence was noted and men and women responded similarly to treatment. The incidence of gastroesophageal reflux symptoms in our patients with globus was 38% v 36% in the general population. Treatment response of the globus symptom was unrelated to treatment response of reflux symptoms even with antireflux therapy. We conclude there is no etiologic relationship between the globus symptom and gastroesophageal reflux.
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PMID:The globus symptom. Incidence, therapeutic response, and age and sex relationships. 713 70

Dysphagia is related to the impairment of food passage from the mouth to the stomach. Globus pharyngis implies the frequent and often painful sensation of a lump in the throat that usually does not interfere with swallowing and may even be relieved by food intake. The diagnosis is based upon a careful history, clinical examination, endoscopy, dynamic imaging (videofluoroscopy, cinematography, videosonography) and electrophysiologic procedures (including pharyngoesophageal manometry, electromyography and pH determinations). Structural lesions of the cervical spine such as diffuse idiopathic skeletal hyperostosis are rare causes of dysphagia. Dysphagia following anterior cervical fusion as well as globus and dysphonia due to dysfunction of the vertebral joints are more likely. Symptoms with swallowing fluids indicate a neurogenic origin. Dyscoordinated swallowing, nasal reflux, dysphonia or general weakness may also occur. Chronic aspiration with respiratory compromize is the main consequence in a variety of neurological disorders as well as in cases of postsurgical dysphagia. Relaxation of the upper esophageal sphincter indicates coordinated muscle movement between the pharynx and esophagus. Dysfunction of the pharyngoesophageal segment may lead to cricopharyngeal achalasia. A dyskinetic sphincter commonly represents an extrapharyngeal cause: i.e., disease associated with gastroesophageal reflux. Disorders of the esophageal phase of deglutition can produce retrosternal pain, heartburn, regurgitation and vomiting, as well as laryngeal and respiratory signs. Esophageal motility disorders include lower achalasia, tumors, peptic strictures, inflammatory diseases, drug-induced ulcers, rings and webs. Motility disorders present with aperistaltic, spontaneous contractions, diffuse esophagospasm, or a hypermotile esophagus. Gastroesophageal reflux with esophagitis must always be excluded, especially in patients with a globus sensation. The multiple features of the appearance of the symptoms of dysphagia and globus makes multidisciplinary approach necessary in order to establish a diagnosis and begin effective treatment.
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PMID:[Deglutition disorders]. 977 28

Globus pharyngeus as a possible presenting symptom of a pharyngeal or upper oesophageal neoplasm is the main reason why barium swallows are requested, although it is essentially a benign disorder that in many cases requires reassurance only. We therefore retrospectively reviewed all barium swallows done in our department for globus pharyngeus during a one-year period to assess their value in the investigation of this condition. Ninety-two patients were identified. All had a normal ENT examination, and symptoms suggestive of acid reflux was the most common associated complaint, at 11 per cent. Acid reflux (18.5 per cent) and hiatus hernia (12 per cent) were the commonest findings of a barium swallow. Three cases of suspicious findings on barium swallow had a normal examination under general anaesthetic. Statistical analysis showed no significant relationship between the symptoms of globus and the barium swallow results. A barium swallow does not seem to add any further useful information to the investigation of globus pharyngeus. But most globus patients will continue to undergo a barium swallow, because although alternative investigations have been extensively assessed, it is still not clear which is the most appropriate mode of investigation for this condition.
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PMID:Value of barium swallow in investigation of globus pharyngeus. 1117 65

Globus pharyngeus is a symptom commonly encountered in ENT practice. The usual complaint is that of the sensation of a ball or lump in the throat generally unaccompanied by dysphagia. This sensation is often more pronounced when taking an 'empty swallow'. The precise mechanism of this remains enigmatic in many cases. Irritant factors such as gastroesophageal reflux, postnasal drip and excessive throat clearing may be contributory factors as may be stress and psychological influences. Although gastric type mucosa occupying the cervical oesophagus has been long recognised, mainly in the specialised gastrointestinal literature, there appears to be more limited awareness of the condition in ENT practice and the clinical significance of such heterotopia is not well established. We present five recent cases of globus pharyngeus encountered in our ENT practice in which rigid pharyngoesophagoscopy and biopsy revealed heterotopic gastric mucosa within the postcricoid and cervical oesophagus constituting a so-called gastric 'inlet patch'. One case re-presented with invasive adenocarcinoma within a short time. Herein we compare and contrast inlet patch with columnar lined oesophagus, discuss the potential clinical significance of inlet patch and comment upon further management of the condition.
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PMID:Heterotopic gastric mucosa in the cervical oesophagus (inlet patch) and globus pharyngeus--an under-recognised association. 1716 26

Globus is a common functional symptom without a clearly accepted etiology. Upper esophageal sphincter (UES) hypertension and gastroesophageal reflux have been proposed but not confirmed. Kwiatek et al. report a detailed study in globus patients using high-resolution manometry (HRM). The study showed greater respiratory augmentation of UES pressure compared with control groups among two-thirds of globus patients. Further prospective studies are needed to confirm these findings and to establish whether they are of etiologic significance.
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PMID:Globus: are we any nearer to understanding it? 1917 89

Globus is a persistent or intermittent non-painful sensation of a lump or foreign body in the throat. It is a commonly encountered clinical condition that is usually long-lasting, difficult to treat, and has a tendency to recur. Furthermore, due to the uncertain etiology of globus, it remains difficult to establish standard investigation and treatment strategies for affected patients. As a first step for managing globus, careful history taking and nasolaryngoscopy are essential. Given the benign nature of the condition and the recent notion that gastroesophageal reflux disease is a major cause of globus, empirical therapy with a high dose of proton pump inhibitors is reasonable for patients with typical globus. If patients are nonresponsive to this therapy, definitive assessments such as endoscopy, multichannel intraluminal impedance/pH monitoring, and manometry should be considered. Speech and language therapy, anti-depressants, and cognitive-behavioral therapy can be helpful in patients whose symptoms persist despite negative investigations.
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PMID:Globus pharyngeus: a review of its etiology, diagnosis and treatment. 2265 43

Globus hystericus (GH) is a subjective feeling of a lump or foreign body in the throat thought to involve psychogenic factors, a form of somatisation disorder. The more modern terms, globus sensation or globus pharyngeus, reflect recognition of one or more possible contributing anatomico-physiological factors, such as gastro-oesophageal reflux disease (GORD) or pharyngeal inflammation.
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PMID:Globus hystericus. 2413 Sep 67

Globus is a topic of interest for many specialties including otorhinolaryngology, gastroenterology and psychiatry/psychosomatic medicine, but, although many hypotheses have been suggested, key questions about its aetiology remain. This Review provides an overview of the extensive literature concerning this topic and discusses the quality of the evidence to date. Globus has been associated with oropharyngeal structural lesions, upper oesophageal sphincter disorders, oesophageal disorders, GERD, psychosocial factors and psychiatric comorbidity. However, findings are often contradictory and the literature remains highly inconclusive. Indeed, with the exception of patients with structural-based globus, the Rome III criteria for functional globus only apply to a subgroup of patients with idiopathic globus. In clinical reality, there exists a group of patients who present with idiopathic (nonstructural) globus, but nevertheless have dysphagia, odynophagia or GERD-exclusion criteria for globus diagnosis according to Rome III. The symptomatology of patients with globus might be broader than previously thought. It is therefore crucial to approach globus not from one single perspective, but from a multifactorial point of view, with focus on the coexistence and/or interactions of different mechanisms in globus pathogenesis. This approach could be translated to clinical practice by adopting a multidisciplinary method to patients presenting with globus.
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PMID:The complexity of globus: a multidisciplinary perspective. 2429 83


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