The diagnosis and management of globus: a perspective from Japan

Abstract

Purpose of review: The etiology of globus is multifactorial and its management is controversial. Recent findings in the etiology and diagnosis of globus are discussed, and a subjective opinion on its management is presented.

Recent findings: Although there is considerable debate concerning the role of gastroesophageal reflux disease (GERD) in patients with globus, the globus symptom score has been shown to be significantly higher in patients with GERD than in those without GERD. This definite association between GERD and globus leads to the practical division of patients with globus into two groups: the GERD/laryngopharyngeal reflux (LPR)-induced and non-GERD/LPR groups. When the presence of GERD or LPR or both is established in patients with globus, management of this condition should be considered. Owing to limitations in the technology for the detection of GERD/LPR, precise discrimination between the two groups is still difficult. For practical purposes, empirical approaches for targeting GERD in patients with globus appear to be justified. A 24 h pH-metry/multichannel intraluminal impedance test may increase the detection of reflux events in patients with globus.

Summary: A practical approach for dividing patients with globus into GERD/LPR-induced and non-GERD/LPR groups is introduced.