What is the treatment for globus sensation (globus pharyngeus)?

From the Guidelines

Treatment for globus sensation typically begins with reassurance that the condition is benign, as this uncomfortable feeling of a lump or tightness in the throat often has no serious underlying cause. Initial management includes lifestyle modifications such as stress reduction techniques (deep breathing, meditation), avoiding throat clearing and excessive swallowing, and staying well-hydrated 1. Dietary changes can help, particularly avoiding spicy foods, caffeine, alcohol, and very hot or cold beverages. For patients with suspected acid reflux contributing to symptoms, proton pump inhibitors like omeprazole (20-40mg daily) or pantoprazole (40mg daily) for 4-8 weeks may provide relief, as suggested by the management of functional communication, swallowing, cough and related disorders: consensus recommendations for speech and language therapy 1.

Some key points to consider in the management of globus sensation include:

• Reassurance and education about the condition, its benign nature, and the good prognosis for resolution 1
• Symptomatic treatment, such as reduction of excessive musculoskeletal tension in speech and non-speech muscles, and elimination of secondary or accessory movements 1
• Psychological support, including attention to psychosocial issues, cognitive features related to locus of control, executive function, abnormal illness beliefs, hypervigilance to bodily functions, etc. 1
• Medical management, such as selective serotonin reuptake inhibitor (SSRI) antidepressants or low-dose amitriptyline, may be helpful for globus sensation, especially if there is a suspected link to anxiety or depression 1

Speech therapy focusing on throat relaxation exercises and proper swallowing techniques can be beneficial, and may help to resolve symptoms of globus sensation, especially when combined with lifestyle modifications and dietary changes 1. For severe anxiety-related globus, short-term anxiolytics might be considered, though cognitive behavioral therapy is often more appropriate for long-term management. If symptoms persist beyond 4-6 weeks or are accompanied by difficulty swallowing, weight loss, or pain, further evaluation with laryngoscopy or barium swallow studies should be pursued to rule out more serious conditions. Most cases of globus sensation resolve with conservative management and time as the throat muscles relax and inflammation subsides.

From the Research

Treatment Options for Globus Sensation

• The treatment for globus sensation often involves a combination of pharmacologic intervention and cognitive-behavioral intervention, as an integrated treatment approach 2.
• Empirical therapy with a high dose of a proton pump inhibitor (PPI) is considered to be indicated for patients with globus sensation, after excluding organic diseases such as pharyngeal cancer, Zenker's diverticulum, or thyroid enlargement 3.
• If patients are nonresponsive to PPI therapy, evaluation of esophageal motility should be done, and prokinetics alone or adding prokinetics to PPI may be considered as a treatment option 3.
• For patients without any esophageal motility dysfunctions who are nonresponsive to PPI therapy, cognitive-behavioral therapy, anti-depressants, or gabapentin could be helpful 3.
• A trial of acid-suppressive therapy may be reasonable in the absence of alarm symptoms, especially if concurrent reflux symptoms are identified 4.
• Ablation of heterotopic gastric mucosa in the proximal esophagus has been reported to improve globus symptoms 4.
• Reassurance, neuromodulators, and complementary approaches may also be used in the management of idiopathic globus 4.

Pharmacologic Treatment

• Proton pump inhibitors (PPIs) such as lansoprazole, omeprazole, pantoprazole, and rabeprazole have similar potency and efficacy in inhibiting gastric acid secretion 5.
• The choice of PPI does not seem to matter, as they all have similar effects 5.
• H2RA may be preferred for elevated esophageal acid exposure, while transient lower esophageal sphincter relaxation inhibitors may be preferred for elevated reflux episodes 6.
• Neuromodulation/behavioral therapy may be preferred for positive symptom-reflux association 6.