Manometry Identifies Most Common Abnormalities in Patients with Globus Sensation

Among 24-hour dual-probe pH testing, esophageal high-resolution manometry, esophagogastroduodenoscopy (EGD), and contrast videofluoroscopy (esophagram), which modality is most able to identify the common abnormalities seen in patients with globus sensation?

Bottom line: Esophageal high-resolution manometry testing identified the greatest proportion of common abnormalities seen in patients with globus sensation.

BACKGROUND: Globus sensation has long been considered psychological in origin and is, as such, classified among somatoform disorders; however, several lines of evidence indicate that many patients with globus sensation have some organic disease or abnormality. Moreover, the commonly employed clinical workup techniques for these patients yield varying results.

STUDY DESIGN: Retrospective cohort study.

SETTING: Department of Otolaryngology–Head and Neck Surgery, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City.

SYNOPSIS: Researchers mined seven years of electronic health records to identify patients who had received orders for the four most common modalities employed for a primary symptom of globus sensation: 24-hour dual probe pH testing, esophageal high-resolution manometry, EGD, and esophagram. The 172 patients who met the inclusion criteria were predominantly female and had a mean age of 54.4 years. In a retrospective analysis, investigators compared the findings that were identified via use of the primary modalities. Overall, high-resolution esophageal manometry identified more abnormalities (62.8% of subjects), most commonly ineffective esophageal motility. Abnormal esophageal acidification was seen in approximately 30% of subjects who underwent 24-hour dual-probe pH testing. Esophagram imaging identified abnormalities of either esophageal reflux (24.4%) or motility (17.7%), and EGD identified motility abnormalities, including achalasia (22.6%) and reflux esophagitis (9.3%). Overall results of this analysis suggest that globus sensation is associated with esophageal dysmotility and/or gastroesophageal and laryngopharyngeal reflux disease. Psychiatric diagnoses were uncommon in the cohort and thus not coded in this analysis. Hiatal hernia was also not consistently represented in available reports, which resulted in some missing data fields for this variable.

Citation: Van Daele DJ. Esophageal manometry, pH testing, endoscopy, and videofluoroscopy in patients with globus sensation. Laryngoscope. 2020;130:2120-2125