What are the medical causes of globus sensation?

Medical Causes of Globus Sensation

Globus sensation has multiple medical etiologies, with gastroesophageal reflux disease (GERD) being the most commonly identified organic cause, followed by esophageal motility disorders, structural abnormalities of the thyroid/larynx/pharynx, and eosinophilic esophagitis in cases presenting with food bolus obstruction. 1, 2, 3

Gastrointestinal Causes

Gastroesophageal Reflux Disease (GERD)

• GERD is the most frequently identified organic cause of globus after otolaryngological evaluation 2
• Laryngopharyngeal reflux (LPR) represents a subset of GERD patients with specific alterations in upper esophageal sphincter (UES) reflexes that reduce esophageal refluxate clearance and increase likelihood of refluxate penetrating the UES barrier 4
• Esophageal acid reflux has a close relationship with globus sensation 3

Esophageal Motility Disorders

• In PPI-resistant patients with globus, 47.9% demonstrate abnormal esophageal motility 3
• Specific motility disorders identified include:
  • Ineffective esophageal motility (most common abnormality in PPI-resistant cases) 3
  • Achalasia (found in 24 of 73 patients with abnormal function in one study) 5
  • Nonspecific esophageal motor disorders (found in 30 of 73 patients) 5
  • Diffuse esophageal spasms 5
  • "Nutcracker esophagus" 5

Eosinophilic Esophagitis (EoE)

• When food bolus obstruction is present with globus, EoE is the most common cause, found in up to 46% of these cases 1
• Urgent referral to gastroenterology for endoscopic intervention is strongly recommended when food bolus obstruction occurs 1

Other Gastrointestinal Findings

• Inlet patch in the proximal esophagus has been associated with globus, with symptom resolution in some patients after its elimination 2

Structural Abnormalities

Thyroid Disorders

• Thyroid adenomata can cause globus sensation 5
• Thyroid enlargement must be excluded during initial evaluation 3

Pharyngeal and Laryngeal Pathology

• Pharyngeal dysfunction (found in 2 of 73 patients with abnormal pharyngoesophageal function) 5
• Zenker's diverticulum must be excluded through otolaryngological examination 1, 3
• Pharyngeal cancer must be ruled out 3
• Chronic tonsillitis or pharyngitis 5

Cervical Spine

• Cervical spondylosis can present with globus sensation 5

Inflammatory and Mucosal Conditions

• Dry oropharyngeal mucosa 5
• Chronic bronchitis 5

Functional and Hypersensitivity Disorders

• Oropharyngeal hypersensitivity (either chemical or mechanical) can be associated with globus 2
• Upper esophageal sphincter dysfunction with altered reflexes 4

Psychological and Psychiatric Factors

While psychological factors are frequently associated with globus, they are unlikely to be etiologically significant as primary causes 5

• Psychological stress commonly exacerbates symptoms, with many patients reporting worsening during periods of high emotional intensity 6
• In one study, 37 of 58 interviewed patients met criteria for psychiatric disorders 5
• Anxiety was found in 34.95% (definite) and 18.44% (borderline) of patients 7
• Depression was found in 12.5% (definite) and 27.9% (borderline) of patients 7
• However, psychometric scores and psychiatric characteristics were unrelated to the sensation's course, suggesting these are associated rather than causative factors 5

Important Clinical Distinctions

A critical pitfall is mistaking globus for dysphagia, as this leads to inappropriate treatment approaches 6, 1

• True globus typically improves during eating rather than worsening with swallowing food 6, 1
• Approximately 20% of patients with functional dysphagia may experience globus with swallowing, but the improvement with eating distinguishes true globus 6, 1
• Alarm symptoms requiring immediate investigation include weight loss, true dysphagia, and odynophagia (painful swallowing) 1