What is the initial management for a patient presenting to the emergency department with a globus sensation after eating chips, potentially related to Gastroesophageal Reflux Disease (GERD) or an allergic reaction?

From the Guidelines

The initial management for a patient presenting to the emergency department with globus sensation after eating chips should focus on ruling out immediate life-threatening conditions while addressing symptoms. First, assess airway patency and vital signs to ensure there is no acute obstruction or anaphylaxis. If the patient can speak, swallow, and breathe normally, administer an H2 blocker such as famotidine 20mg IV or PO, or a proton pump inhibitor like omeprazole 40mg, to reduce acid production if GERD is suspected, as suggested by recent guidelines 1. For possible allergic reactions, diphenhydramine 25-50mg PO/IV can be given. A thorough history should be obtained regarding the onset, duration, and associated symptoms like heartburn, regurgitation, or prior allergic reactions. Physical examination should include the oropharynx and neck. Patients should be advised to avoid trigger foods, eat smaller meals, and not lie down for 2-3 hours after eating. These interventions work by reducing acid reflux and inflammation that may contribute to the globus sensation.

Key Considerations

• The patient's symptoms could be related to GERD or an allergic reaction, and it's essential to consider both possibilities in the initial management.
• Eosinophilic esophagitis (EoE) is another potential cause of globus sensation, especially if the patient has a history of dysphagia or food bolus obstruction, as noted in recent studies 1.
• The British Society of Gastroenterology guidelines recommend considering EoE in patients with dysphagia or food bolus obstruction, and taking oesophageal biopsies to diagnose EoE if present 1.
• If symptoms persist or worsen, further evaluation with direct laryngoscopy, barium swallow, or endoscopy may be necessary to rule out structural abnormalities or foreign body sensation.

Additional Recommendations

• Patients with a history of food allergies should have an emergency care plan in place, including the administration of epinephrine for any symptoms if the allergen was likely eaten, as outlined in guidelines for childhood food allergies 1.
• For patients with suspected GERD, lifestyle modifications such as avoiding trigger foods, eating smaller meals, and not lying down after eating can help alleviate symptoms, as discussed in the management of pediatric GER 1.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Initial Management

The initial management for a patient presenting to the emergency department with a globus sensation after eating chips, potentially related to Gastroesophageal Reflux Disease (GERD) or an allergic reaction, involves several key considerations:

• Assessing the patient's symptoms and medical history to determine the underlying cause of the globus sensation
• Evaluating the patient for signs of anaphylaxis, a severe and potentially life-threatening allergic reaction, as described in the study by 2
• Considering the possibility of GERD, which can cause symptoms such as heartburn, dysphagia, and acid regurgitation, as discussed in the studies by 3 and 4

Diagnostic Approach

The diagnostic approach for a patient with a globus sensation after eating chips may involve:

• Physical examination to assess for signs of anaphylaxis or other allergic reactions
• Laboratory tests, such as complete blood count (CBC) or electrolyte panel, to rule out other potential causes of the patient's symptoms
• Endoscopy or other imaging studies to evaluate the patient's esophagus and stomach for signs of GERD or other conditions, as described in the study by 4

Treatment Options

Treatment options for a patient with a globus sensation after eating chips may include:

• Administration of epinephrine via intramuscular injection for suspected anaphylaxis, as recommended by the study by 2
• Proton pump inhibitors (PPIs) or H2-receptor antagonists to reduce stomach acid and alleviate symptoms of GERD, as discussed in the studies by 3 and 4
• Avoidance of trigger foods or substances that may be contributing to the patient's symptoms, as suggested by the study by 5

Special Considerations

Special considerations for a patient with a globus sensation after eating chips may include:

• The possibility of eosinophilic esophagitis, a condition characterized by inflammation of the esophagus and symptoms such as dysphagia and food impaction, as described in the study by 5
• The potential for cocaine-induced uvular edema, a condition that can cause symptoms such as globus sensation and sore throat, as reported in the study by 6