Glucagon Is Not Appropriate for Globus Sensation
Glucagon has no role in the treatment of globus sensation and should never be used for this indication. Glucagon is indicated exclusively for severe hypoglycemia in diabetic patients unable to consume oral carbohydrates, and for epinephrine-unresponsive anaphylaxis during allergic reactions 1.
Why This Question Reflects a Fundamental Misunderstanding
Globus sensation is a non-painful feeling of a lump in the throat that characteristically improves during eating rather than worsening with swallowing 2, 3. This is a functional or reflux-related condition, not a medical emergency requiring glucagon.
The confusion likely stems from misunderstanding glucagon's mechanism or mistaking globus for:
- Anaphylactic throat tightening (which glucagon treats only when epinephrine fails in allergic reactions) 1
- Esophageal food bolus obstruction (which requires urgent endoscopy, not glucagon) 3
Correct Treatment Algorithm for Globus Sensation
Step 1: Exclude Red Flags Requiring Urgent Intervention
Screen for alarm symptoms that mandate immediate investigation rather than empirical therapy 3:
- Unexplained weight loss (requires urgent endoscopy)
- True dysphagia that worsens with eating
- Hemoptysis, fever >101.5°F, or night sweats
- Palpable neck mass or lymphadenopathy >1.5 cm
Step 2: Initiate First-Line Therapy
Start high-dose proton pump inhibitor (PPI) therapy (e.g., omeprazole 40 mg twice daily before meals) for 8–12 weeks in patients with typical globus and no alarm features 3, 4. GERD is recognized as a major causative factor, and the benign nature of globus supports empirical acid suppression 3, 4.
Step 3: Add Adjunctive Agents Based on Symptom Phenotype
If breakthrough symptoms persist on PPI alone 3:
- Alginate antacids for intermittent throat symptoms between PPI doses
- Nighttime H2-receptor antagonist (famotidine) for nocturnal symptoms
- Baclofen for regurgitation or belch-predominant symptoms
- Prokinetic agent (metoclopramide) if esophageal dysmotility is documented—present in approximately 48% of PPI-resistant cases 3, 5
Step 4: Consider Neuromodulatory and Behavioral Interventions
For persistent symptoms after adequate PPI trial 3, 6:
- Speech and language therapy is the primary intervention for laryngeal hypersensitivity and functional pharyngolaryngeal tension 3
- Tricyclic antidepressants (imipramine 10–25 mg at bedtime) address visceral hypersensitivity through neuromodulation, not muscle relaxation—effects require several weeks 6
- Cognitive-behavioral therapy and relaxation techniques for stress-exacerbated symptoms 3, 4
Critical Pitfalls to Avoid
- Never use glucagon for globus—it has zero therapeutic rationale and wastes a medication reserved for life-threatening hypoglycemia 1 or anaphylaxis 1
- Do not mistake globus for dysphagia—globus improves with eating; dysphagia worsens 2, 3
- Avoid muscle relaxants (e.g., cyclobenzaprine)—globus is a sensory hypersensitivity phenomenon, not true muscle spasm 6
- Do not terminate PPI trials prematurely—therapeutic effects require 8–12 weeks, not days 3
- Do not order imaging (CT, MRI, barium studies) for uncomplicated globus—these are inappropriate initial investigations for a functional condition 3