Globus Sensation and Swallowing Food
Globus sensation typically improves during eating rather than worsening when swallowing food. 1
Characteristics of Globus Sensation
Globus pharyngeus presents as a recurrent, non-painful but uncomfortable sensation of a lump in the throat with the following key features:
- It is more obvious between meals and typically improves with eating, contrary to worsening during swallowing 1, 2
- It presents as a sensation of a foreign body, tightening, choking feeling, or lump in the throat 1
- While swallowing food, patients may experience a sense of food sticking or passing with difficulty through the esophagus, but the primary globus sensation itself tends to improve during the act of eating 1, 3
- It is felt medially deep in the throat during empty swallowing, not while drinking or eating 2
Distinguishing Features
- Globus must be distinguished from dysphagia (difficulty swallowing), which is a separate condition, although they can co-occur in some patients 1
- Approximately 20% of patients with functional dysphagia may experience globus sensation with swallowing, but true globus typically improves rather than worsens with food intake 1
- Unlike dysphagia, globus does not cause hindrance for the passage of food 2, 3
- Globus sensation is persistent or intermittent and is not associated with pain during swallowing 1, 3
Associated Conditions and Management
- Globus sensation is often linked to psychological stress, with many patients reporting symptom exacerbation during periods of high emotional intensity 1
- It commonly co-occurs with functional voice disorders and is frequently associated with throat clearing, sense of mucus buildup, dry throat, and repeated swallowing 1
- For patients with typical globus symptoms, empirical therapy with proton pump inhibitors is reasonable as gastroesophageal reflux disease is considered a major cause 4, 5
- If symptoms persist despite treatment, further evaluation including endoscopy, manometry, and pH monitoring may be warranted 4, 5, 3
Common Pitfalls
- Mistaking globus for dysphagia can lead to inappropriate treatment approaches 1
- Failing to recognize that alarm symptoms such as pain, weight loss, true dysphagia, or odynophagia require thorough investigation to rule out serious conditions 3
- Overlooking that globus symptoms can be caused by various conditions including cervical disturbances, reflux, or early hypopharyngeal cancer 2
- Not recognizing that hypnotically-assisted relaxation therapy can be an effective treatment option for persistent globus sensation 6
In summary, the defining characteristic of globus sensation is that it typically improves rather than worsens during eating or drinking, which helps distinguish it from true dysphagia.