OVERVIEW

What is globus pharyngeus?

Globus pharyngeus, also known as "globus sensation," is a common functional esophageal disorder in clinical practice.

What are the main symptoms of globus pharyngeus?

The primary manifestation is a sensation of a lump or foreign body stuck in the throat.

How is globus pharyngeus diagnosed?

It can only be diagnosed after ruling out structural esophageal abnormalities, gastroesophageal reflux disease, esophageal mucosal disorders, or motility dysfunction.

Who is most commonly affected by globus pharyngeus?

It predominantly occurs in women, especially those going through menopause.

What is globus pharyngeus associated with?

The exact cause and mechanism remain unclear but may involve visceral hypersensitivity, upper esophageal sphincter dysfunction, psychological factors, and reflux. Many patients exhibit psychological triggers and obsessive-compulsive tendencies.

Is globus pharyngeus common?

It is relatively common among patients visiting otolaryngology clinics. A University of Sydney study found its prevalence to be 6.7 per 100,000, meaning approximately 6.7 people in 100,000 may develop this condition.

SYMPTOMS

What are the clinical manifestations of globus pharyngeus?

Patients often experience a sensation of a lump, foreign body adhesion, or tightness in the throat. Globus pharyngeus is usually painless, with symptoms more noticeable when swallowing saliva or dry swallowing, but less obvious when drinking water or eating solid food. In most cases, symptoms are intermittent rather than persistent.

High-risk patients may sometimes exhibit alarm symptoms, which strongly suggest the possibility of globus pharyngeus, such as:

• Neck or throat pain;
• Weight loss;
• Sudden onset after age 50;
• Pain, choking, or difficulty swallowing;
• Food regurgitation;
• Muscle weakness;
• Palpable or visible mass;
• Progressive worsening of symptoms.

Patients with globus pharyngeus may also experience emotional distress. While focusing on symptom relief, it’s important to address emotional well-being. Lifestyle changes such as meditation and exercise can help improve mood, and psychological counseling may assist in resolving emotional difficulties. Additionally, understanding and support from family can greatly aid emotional recovery.

Can globus pharyngeus progress to a tumor? What is its disease course?

Globus pharyngeus is a benign condition and does not progress to a tumor. Studies show that 70% of patients experience intermittent symptoms, and the lifetime prevalence is only 22%, meaning it may occur only during a certain period in life.

Under what circumstances should globus pharyngeus be suspected?

Globus pharyngeus should be suspected when a patient reports a sensation of a lump or foreign body in the throat. If the patient experiences unresolved emotional distress or pathological grief, chronic symptoms (such as throat discomfort) may arise, with relief after crying, suggesting possible globus sensation. In such cases, globus pharyngeus should be considered.

CAUSES

What are the causes of globus pharyngeus?

To date, the pathogenesis of globus pharyngeus remains unclear. Extensive literature suggests that the condition may be related to visceral hypersensitivity, abnormal upper esophageal sphincter function, psychological factors, and reflux:

• Visceral hypersensitivity: Heightened sensitivity to balloon dilation is a common feature in patients with globus pharyngeus.

• Abnormal upper esophageal sphincter function: Such as cricopharyngeal hypertension, hypotension, or relaxation abnormalities.

• Psychological factors: Many patients with globus pharyngeus exhibit various forms of emotional disorders, such as obsessive symptoms, depression, and anxiety.

• Gastroesophageal reflux: In some patients, globus pharyngeus is an atypical manifestation of gastroesophageal reflux disease. It has been speculated that globus pharyngeus may be related to upper esophageal sphincter contraction caused by distal esophageal acid exposure.

Who is more prone to globus pharyngeus?

Studies indicate that patients with globus pharyngeus score higher in neuroticism, introversion, anxiety, and depression compared to the general population, suggesting that individuals with psychological disorders may be more susceptible to the condition. Additionally, it is more common in women, particularly those in menopause.

Is globus pharyngeus contagious?

Globus pharyngeus is not an infectious disease and is not contagious.

Is globus pharyngeus hereditary?

Furthermore, there is currently no literature indicating a genetic predisposition for globus pharyngeus.

DIAGNOSIS

What tests are needed to diagnose globus pharyngeus?

For typical globus pharyngeus, no additional tests are required. If the diagnosis is unclear or the doctor cannot fully examine the pharynx, further tests for dysphagia may be needed, such as nasal endoscopy, laryngoscopy, gastroscopy, esophageal manometry, esophageal pH monitoring, neck CT or MRI, barium swallow test, or thyroid ultrasound.

The primary purpose of these tests is to rule out other possible organic diseases. Doctors can select the appropriate tests as needed.

How is globus pharyngeus diagnosed?

Globus pharyngeus is diagnosed through a stepwise approach:

• First, patients with symptoms of globus pharyngeus require a detailed medical history and physical examination of the throat.

• Second, if conservative treatment fails or if alarm symptoms (such as pain, odynophagia, dysphagia, hoarseness, unilateral symptoms, neck or tonsil masses, etc.) are present, further tests are needed to exclude other causes and confirm the diagnosis.

• Finally, a definitive diagnosis of globus pharyngeus requires meeting all of the following criteria:

• Typical globus symptoms with no structural abnormalities found on examination or endoscopy.

• Symptoms occur between meals.

• No odynophagia or dysphagia.

• Exclusion of gastroesophageal reflux disease (GERD) and eosinophilic esophagitis.

• Exclusion of esophageal motility disorders (such as achalasia, esophagogastric junction outflow obstruction, distal esophageal spasm, etc.).

• No esophageal inlet patch.

• Symptoms persist for over six months, with the last three months meeting the above criteria.

What diseases should globus pharyngeus be differentiated from?

Since many esophageal conditions can cause symptoms similar to globus pharyngeus, it must be distinguished from achalasia, esophageal motility disorders, GERD, tongue base tumors, cervical lymphadenopathy, goiter, hiatal hernia, tonsillar hyperplasia, and other conditions.

TREATMENT

Which department should I visit for globus pharyngeus?

For globus pharyngeus, you should visit gastroenterology, otolaryngology, psychiatry/psychology, or thoracic surgery.

Does globus pharyngeus require treatment?

Globus pharyngeus requires treatment.

What complications might patients with globus pharyngeus experience?

• Some patients may develop chronic pharyngitis, laryngitis, tonsillitis, sinusitis, esophagitis, or esophageal diverticulum, as well as esophageal cancer, tonsillar cancer, tongue cancer, or laryngeal cancer.

• In women, it may primarily manifest as hypogonadism or hypothyroidism.

• Psychological factors can also play a role. Some individuals may experience intense emotional stimuli, such as fear, shock, anxiety, or grief, which can stimulate the hypothalamus (the autonomic nerve center) and lead to autonomic dysfunction, resulting in throat edema and abnormal sensations. Sometimes, functional disorders can cause esophageal muscle spasms or impaired esophageal motility, leading to postprandial throat discomfort or dysphagia.

What are the treatment options for globus pharyngeus?

Treatment for globus pharyngeus is divided into stages, including initial and follow-up therapy.

• Initial treatment includes conservative therapy and medication:

• Conservative therapy involves psychological counseling, reassuring patients that globus pharyngeus is a benign condition and encouraging relaxation to aid recovery.

• Medication primarily involves proton pump inhibitors (e.g., omeprazole) for acid suppression. If symptoms do not improve within 6–8 weeks, this treatment should be discontinued.

• Patients who do not respond to initial treatment require further evaluation for structural abnormalities, gastroesophageal reflux disease (GERD), or esophageal motility disorders. Follow-up treatments include antidepressants (e.g., amitriptyline) and other therapies (e.g., gabapentin, hypnotherapy, esophageal inlet patch ablation).

• Antidepressants are recommended only for patients with persistent symptoms after acid suppression therapy, particularly those with comorbid psychiatric disorders (e.g., panic disorder, somatic symptom disorder, major depression, or agoraphobia).

Can globus pharyngeus be completely cured?

Globus pharyngeus follows a benign course. Studies indicate that about 25% of patients experience complete symptom resolution after 27 months of follow-up, meaning some patients can achieve a full cure.

DIET & LIFESTYLE

What should be noted about globus pharyngeus?

• First, correctly understand the disease of globus pharyngeus, help patients build confidence in overcoming the condition, and actively cooperate with doctors' treatment;

• Second, it is necessary to relax. If there is significant anxiety or depression, seeking help from a psychological department may help control the condition;

• Finally, if symptoms still show no significant improvement after 8 weeks of using acid-suppressing drugs, further examinations are needed to rule out other diseases.

Can patients with globus pharyngeus have children?

Existing literature has not reported that globus pharyngeus affects patients' fertility, nor is there clear evidence that the offspring of patients will necessarily develop the condition. Therefore, as long as the disease is treated correctly, globus pharyngeus does not affect patients' normal lives, and they can marry and have children.

PREVENTION

Can globus pharyngeus be prevented?

Since the cause and pathogenesis of globus pharyngeus are not yet fully understood, there is no specific method to prevent its occurrence.