From the Guidelines
Globus pharyngeus in a child is a functional disorder characterized by a recurrent, non-painful sensation of a lump in the throat, and its diagnosis is one of exclusion.
Diagnosis
The diagnosis of globus pharyngeus is based on the presence of specific symptoms, including a sensation of a foreign body in the throat, a tightening or choking feeling, or a lump in the throat, in the absence of dysphagia, odynophagia, gastro-oesophageal reflux disease (GORD/GERD), or a histopathology-based oesophageal motility disorder 1.
- The Rome IV criteria are often used to define globus pharyngeus as a diagnosis of exclusion within gastroenterology.
- A thorough medical evaluation is necessary to rule out other potential causes of the symptoms.
Treatment
Treatment of globus pharyngeus in a child typically involves a multidisciplinary approach, including education, symptomatic relief, and psychological support.
- Education and reassurance regarding the nature of the symptoms and good prognosis for resolution are essential 1.
- Symptomatic relief may be achieved through techniques such as reduction of excessive musculoskeletal tension, elimination of secondary or accessory movements, and focusing on normal movements and sounds.
- Psychological support, including counseling and cognitive behavioral therapy, may be helpful in addressing underlying psychological stress and anxiety that may be contributing to the symptoms 1.
- Medical management, such as selective serotonin reuptake inhibitor (SSRI) antidepressants or low-dose amitriptyline, may be considered in some cases 1.
- It is also important to provide information and advice to reduce acid reflux and signpost for appropriate medical management of acid reflux and/or postnasal drip if present 1.
From the Research
Diagnosis of Globus Pharyngeus in Children
- The diagnosis of Globus pharyngeus is based on the sensation of a lump or foreign body in the throat, generally not accompanied by pain and relieved by eating 2, 3.
- A careful history taking and nasolaryngoscopy are essential as a first step for managing Globus pharyngeus 4.
- The diagnosis can be challenging due to the uncertain etiology of Globus pharyngeus, and there is no consensus on the management and treatment of the condition 2, 5.
Treatment of Globus Pharyngeus in Children
- Empirical therapy with a high dose of proton pump inhibitors is reasonable for patients with typical Globus pharyngeus, given the recent notion that gastroesophageal reflux disease is a major cause of Globus 4.
- If patients are nonresponsive to this therapy, definitive assessments such as endoscopy, multichannel intraluminal impedance/pH monitoring, and manometry should be considered 4.
- Speech and language therapy, anti-depressants, and cognitive-behavioral therapy can be helpful in patients whose symptoms persist despite negative investigations 4.
- There is no reliable diagnostic test or treatment modality for Globus pharyngeus, and randomized controlled trials are still lacking in the literature 5.