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Original Investigation
June 22, 1998

Globus Sensation: Pharyngoesophageal Function, Psychometric and Psychiatric Findings, and Follow-up in 88 Patients

Author Affiliations

From the Psychophysiology Unit, Department of Surgery (Drs Stelzeneder, Vacariu-Granser, and Stacher and Mss Weber, Schneider, and Stacher-Janotta), Psychosomatic Clinic, Department of Medicine IV (Dr Moser), the Divisions of Social Psychiatry and Evaluation Research (Drs Wenzel-Abatzi and Wenzel) and General Psychiatry (Dr Wiesnagrotzki), the Department of Psychiatry; and the Departments of Radiology (Drs Schima and Pokieser) and Biomedical Engineering and Medical Physics (Dr Bergmann), University of Vienna School of Medicine; and the Ludwig Boltzmann Institute of Nuclear Medicine (Dr Bergmann), Vienna, Austria.

Arch Intern Med. 1998;158(12):1365-1373. doi:10.1001/archinte.158.12.1365

Background  The globus sensation has been widely regarded as psychogenic, but organic disorders were found to be etiologically significant.

Objective  To investigate the structural, functional, psychological, and psychiatric factors possibly eliciting the globus sensation and influencing its course.

Methods  Eighty-eight patients, 67 women and 21 men (aged 22-71 years), referred to 2 tertiary care centers underwent history taking, otolaryngological examination, pharyngoesophageal videofluoroscopy and manometry, psychosocial evaluation, psychometric tests, psychiatric interview, and when indicated, esophagogastroduodenoscopy, esophageal bolus transport, gastroesophageal reflux, and gastric emptying studies. According to revealed disorders, therapy was initiated, and the outcome was studied.

Results  Only 15 patients had normal pharyngoesophageal function; of these 15, 6 had chronic tonsillitis or pharyngitis, 3 had thyroid adenomata, 4 had cervical spondylosis, and 1 each had dry oropharyngeal mucosa and chronic bronchitis. Of the other 73 patients, 2 had pharyngeal dysfunction, 24 had achalasia, 1 had diffuse esophageal spasms, 3 had "nutcracker esophagus," 30 had nonspecific esophageal motor disorders, and 13 had gastroesophageal reflux. Psychometry revealed no more anxiety and depression than in general medical outpatients. Of 58 patients interviewed, 37 met criteria for psychiatric disorders. Psychometric scores and psychiatric characteristics were unrelated to the sensation's course. Therapy was recommended, but only 26 patients were treated accordingly; 22 received nonspecific treatment. Follow-up 3 to 59 months later revealed that the sensation had vanished in 13 patients who had received specific treatment, 5 who had received nonspecific treatment, and 6 who had received no treatment; it was alleviated in 10 who had received specific treatment, 13 who had received nonspecific treatment, and 9 who had received no treatment; and it was unchanged in 3 who had received specific treatment, 5 who had received nonspecific treatment, and 23 patients who had received no treatment.

Conclusions  Pharyngoesophageal disorders may be sensed only vaguely, inducing the globus sensation. Psychological and psychiatric characteristics could be relevant to the discomfort experienced but are unlikely to be etiologically significant.