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Chen X, Zhou S, Shi C, Feng M, ZhuoMa G, Shen D, Wang T, Zhang J. Association of Heterotopic Gastric Mucosa in the Upper Esophagus (HGMUE) with Pharyngolaryngeal Symptoms: A Systematic Review and Meta-Analysis. Dig Dis Sci 2024; 69:4416-4429. [PMID: 39495415 PMCID: PMC11602832 DOI: 10.1007/s10620-024-08699-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2024] [Accepted: 10/16/2024] [Indexed: 11/05/2024]
Abstract
BACKGROUND Heterotopic gastric mucosa in the upper esophagus (HGMUE) is considered to be accompanied by pharyngolaryngeal symptoms, whereas the association strength between HGMUE and pharyngolaryngeal symptoms remains controversial. This study assessed the strength of the association between HGMUE and pharyngolaryngeal symptoms using a meta-analytic approach. METHODS PubMed, Embase, Web of Science, and CNKI databases were searched for relevant articles published between January 2010 and January 2024. The pharyngolaryngeal symptoms of chronic cough, dysphagia, hoarseness, and globus in patients with HGMUE were summarized. The pooled odds ratio (OR) and 95% confidence interval (CI) were calculated using a random-effects model. The exploratory analyses were also performed, including sensitivity and subgroup analyses. RESULTS A total of 17 observational studies (1 cohort study and 16 cross-sectional studies) with 626,369 patients (2414 HGMUE patients and 623,955 non-HGMUE patients) were included in the meta-analysis. HGMUE was significantly associated with an elevated incidence of chronic cough (OR: 3.36; 95% CI 1.25-9.01; P = 0.02), dysphagia (OR: 1.58; 95% CI 1.12-2.25; P = 0.01), hoarseness (OR: 4.13; 95% CI 1.47-11.56; P = 0.007), and globus (OR: 2.41; 95% CI: 1.43-4.04, P < 0.001). The association between HGMUE and the risk of dysphagia was found to be potentially influenced by study design, sample size, country, and diagnostic method, whereas the association between HGMUE with the risk of globus was potentially affected by the study design and country. CONCLUSION HGMUE was significantly associated with chronic cough, dysphagia, hoarseness, and globus. HGMUE should be taken into consideration for patients with pharyngolaryngeal symptoms.
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Affiliation(s)
- Xuanran Chen
- The Second School of Clinical Medicine, Hangzhou Normal University Hangzhou, Zhejiang, China
| | - Shunhai Zhou
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Chaoyi Shi
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Mingzhi Feng
- Department of Gastroenterology, Center for General Practice Medicine, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, China
| | - GeSang ZhuoMa
- Department of Gastroenterology, Center for General Practice Medicine, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, China
| | - Diyun Shen
- The First Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Tianyue Wang
- The First Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Jun Zhang
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), Hangzhou, Zhejiang, China.
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Rathod V, A. A, Ramesh NK, Shaikh MK. Heterotopic Gastric Mucosa in the Proximal Esophagus (Inlet Patch): Endoscopic Prevalence, Clinico-pathological Characteristics and Its Association with Helicobacter pylori. JOURNAL OF DIGESTIVE ENDOSCOPY 2022. [DOI: 10.1055/s-0042-1743182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Abstract
Objective To determine the prevalence of the inlet patch (IP), its clinico-pathological features, and its association with Helicobacter pylori.
Materials and Methods A prospective observational study was performed on 1,889 patients referred for esophagogastroduodenoscopy for various reasons, primarily for the evaluation of dyspepsia. All patients were enquired about the presence of symptoms and carefully examined for the presence of IP during upper gastrointestinal (GI) endoscopy. Biopsies were taken from the patients who had IP.
Statistical Analysis All statistical analyses were performed using the Statistical Package for Social Sciences (SPSS) 13.0 software for Windows XP. Categorical variables were compared using the chi-squared test or Fisher's exact test and continuous variables were compared using Student's t-test and univariate analysis. A P-value of less than 0.05 was considered to be statistically significant.
Results Inlet patches were found in 34 of 1,889 patients (1.8%). H. pylori was identified in 23.52% of patients (8/34) with IP. Gastric H. pylori infection was positive in all (08/08) patients who had IP. Colonization of H. pylori was more common in antral type mucosa (6/8). H. pylori positivity in the IP correlated with globus sensation symptom in our study, 87.5% of patients with IP and H. pylori positive had globus sensation.
Conclusion The prevalence of IP seems to be underestimated. H. pylori colonization of the IP is common and it positively correlates with globus sensation and is closely related to the H. pylori density in the stomach. Though preneoplasia within IP is rare, which does not support the recommendation to regularly obtain biopsies for histopathology, it might be beneficial in a subset of patients with persistent globus sensation.
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Affiliation(s)
- Vivek Rathod
- Department of Digestive Health and Disease, Kilpauk Medical College, Chennai, Tamil Nadu, India
| | - Anand A.
- Department of Digestive Health and Disease, Kilpauk Medical College, Chennai, Tamil Nadu, India
| | | | - Mohamed Kani Shaikh
- Department of Digestive Health and Disease, Kilpauk Medical College, Chennai, Tamil Nadu, India
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Van Daele DJ. Esophageal Manometry, pH Testing, Endoscopy, and Videofluoroscopy in Patients With Globus Sensation. Laryngoscope 2019; 130:2120-2125. [DOI: 10.1002/lary.28289] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 08/14/2019] [Accepted: 08/19/2019] [Indexed: 12/12/2022]
Affiliation(s)
- Douglas J. Van Daele
- Department of Otolaryngology–Head and Neck SurgeryRoy J. and Lucille A. Carver College of Medicine, University of Iowa Iowa City Iowa U.S.A
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Ahmed ME, Ahmed MER, El Batawi AM, Abdelfattah HM, Jelassi N. Internal Hypopharyngeal Cyst: A Review of Literature. Dysphagia 2019; 34:487-498. [PMID: 30927081 DOI: 10.1007/s00455-019-10003-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 03/23/2019] [Indexed: 02/06/2023]
Abstract
Detailed information on the hypopharyngeal cyst presentation, terminology, classification, diagnosis, management, and possible complication is scarce though it would lead to life-threatening symptoms. This review article, therefore, meticulously presents and analyzes the majority of the pertaining literature. In this context, a particular emphasis has been placed on the embryological development of the branchial arches while discussing each entity that would improve the current understanding of different pharyngeal cyst's pathologies.
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Affiliation(s)
| | - Mona El-Rabie Ahmed
- Department of Phoniatrics, Otorhinolaryngology-Head and Neck Surgery, Sohag University, Egypt-Sohag-Nasr City, Eastern Avenue, University Street, Sohag, 82524, Egypt.
| | | | | | - Noura Jelassi
- Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine, Tunisia University, Tunis, Tunisia
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Penović S, Roje Ž, Brdar D, Gračan S, Bubić A, Vela J, Punda A. Globus Pharyngeus: A Symptom of Increased Thyroid or Laryngopharyngeal Reflux? Acta Clin Croat 2018; 57:110-115. [PMID: 30256018 PMCID: PMC6400352 DOI: 10.20471/acc.2018.57.01.13] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
SUMMARY – The aim of this study was to investigate the relationship between globus pharyngeus and laryngopharyngeal reflux, as well as between globus and thyroid volume. A two-year prospective study included 56 patients aged 18-75 with globus symptom. Anthropometric, clinical and laboratory data were collected. All patients filled-out the Glasgow Edinburgh Throat Scale (GETS) and then underwent thyroid ultrasound. Morphological changes of the larynx were detected by direct laryngoscopy and classified by the Reflux Finding Score (RFS). If RFS >7, the diagnosis of laryngopharyngeal reflux was made and therapy with proton pump inhibitors initiated. According to GETS, there was significant difference between patients with normal volume and those with large thyroid volume. There was no statistically significant difference between patients with RFS <7 and RFS >7. In conclusion, the incidence and severity of globus pharyngeus do not definitely indicate laryngopharyngeal reflux. It is more common in patients with normal thyroid volume.
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Affiliation(s)
| | - Željka Roje
- Private Practice of Otorhinolaryngology, Split, Croatia
| | - Dubravka Brdar
- Department of Nuclear Medicine, Split University Hospital Centre, Split, Croatia
| | - Sanda Gračan
- Department of Nuclear Medicine, Split University Hospital Centre, Split, Croatia
| | - Ana Bubić
- Institute of Emergency Medicine of Split-Dalmatia County, Split, Croatia
| | - Jadranka Vela
- University Department of ENT, Head and Neck Surgery, Split University Hospital Centre, Split, Croatia
| | - Ante Punda
- Department of Nuclear Medicine, Split University Hospital Centre, Split, Croatia
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Di Nardo G, Cremon C, Bertelli L, Oliva S, De Giorgio R, Pagano N. Esophageal Inlet Patch: An Under-Recognized Cause of Symptoms in Children. J Pediatr 2016; 176:99-104.e1. [PMID: 27318379 DOI: 10.1016/j.jpeds.2016.05.059] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Revised: 04/13/2016] [Accepted: 05/18/2016] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To determine the incidence of inlet patch (IP) and to assess the clinical and pathological features, role of the diagnostic workup in treatment decision making, efficacy of medical and endoscopic therapy, and natural history in a pediatric population. STUDY DESIGN Consecutive patients aged <18 years (n = 1000) undergoing esophagogastroduodenoscopy were enrolled prospectively. Biopsy specimens were obtained from IPs and the proximal and distal esophagus, stomach, and duodenum. Multichannel intraluminal impedance and pH monitoring (MII-pH) was performed in all symptomatic patients. Symptomatic patients were treated with proton pump inhibitors for 8 weeks, and IP ablation by argon plasma coagulation (APC) was performed in unresponsive patients. RESULTS The endoscopic incidence of IP was 6.3%, with a cumulative missing rate of 5.8%. Thirty-five of the 63 patients (56%) were asymptomatic, 11 (17%) had symptoms clearly related to the underlying digestive disorder, and 17 (27%) had chronic IP-related symptoms. MII-pH was positive in 10 of the 28 symptomatic patients. All 17 patients with IP-related symptoms were unresponsive to proton pump inhibitors and were treated with APC, and all had achieved complete remission by the 3-year follow-up. Patients with underlying disorders were successfully treated with medical therapy, and asymptomatic patients remained symptom-free, with no endoscopic or histological changes seen at the 3-year follow-up. CONCLUSION IP is an under-recognized cause of symptoms in children with unexplained esophageal and respiratory symptoms. MII-pH and bioptic sampling are needed to exclude entities mimicking IP symptoms and to direct therapy. APC is safe and effective for treating IP-related symptoms.
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Affiliation(s)
- Giovanni Di Nardo
- Pediatric Unit, Orvieto Hospital, Orvieto, Italy; Pediatric Gastroenterology Unit, International Hospital Salvator Mundi, Rome, Italy.
| | - Cesare Cremon
- Department of Medical and Surgical Sciences, University of Bologna, St Orsola-Malpighi Hospital, Bologna, Italy
| | - Luca Bertelli
- Department of Medical and Surgical Sciences, University of Bologna, St Orsola-Malpighi Hospital, Bologna, Italy
| | - Salvatore Oliva
- Pediatric Gastroenterology and Liver Unit, Department of Pediatrics, Sapienza University of Rome, Rome, Italy
| | - Roberto De Giorgio
- Department of Medical and Surgical Sciences, University of Bologna, St Orsola-Malpighi Hospital, Bologna, Italy
| | - Nico Pagano
- Department of Medical and Surgical Sciences, University of Bologna, St Orsola-Malpighi Hospital, Bologna, Italy
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Fang Y, Chen L, Chen DF, Ren WY, Shen CF, Xu Y, Xia YJ, Li JW, Wang P, Zhang AR, Shao SZ, Yu XN, Peng GY, Fang DC. Prevalence, histologic and clinical characteristics of heterotopic gastric mucosa in Chinese patients. World J Gastroenterol 2014; 20:17588-17594. [PMID: 25516674 PMCID: PMC4265621 DOI: 10.3748/wjg.v20.i46.17588] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Revised: 05/18/2014] [Accepted: 07/16/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To determine the prevalence, demographic, clinical and histopathologic features of heterotopic gastric mucosa (HGM) in Chinese patients.
METHODS: Patients referred to three endoscopy units were enrolled in this study. The macroscopic characteristics of HGM were documented. Biopsies were obtained and observed using hematoxylin and eosin staining. Helicobacter pylori colonization was examined by Whartin-Starry staining.
RESULTS: HGM was observed in 420 Chinese patients, yielding a prevalence of 0.4%. The majority of patients had a single patch (300/420; 71.4%), while the remainder had two (84/420; 20%) or multiple patches (36/420; 8.6%). The size of the patches and the distance from the patch to the frontal incisor teeth varied significantly. The large majority of HGM patches were flat (393/420; 93.6%), whereas the remaining patches were slightly elevated. The primary histological characteristic was fundic-type (216/420; 51.4%) within the HGM patch, and antral- (43/420; 10.2%) and transitional-type (65/420; 15.5%) mucosa were also observed. The prevalence of intestinal metaplasia was 3.1% (13/420) and the prevalence of dysplasia was 1.4% (6/420), indicating the necessity for endoscopic follow-up in patients with HGM. Esophageal and extraesophageal complaints were also observed in patients with HGM. Dysphagia and epigastric discomfort (odds ratios: 6.836 and 115.826, respectively; Ps < 0.05) were independent risk factors for HGM.
CONCLUSION: Clinical complaints should be considered to improve the detection rate of HMG. The prevalence of intestinal metaplasia and dysplasia also indicates a need for endoscopic follow-up.
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Abstract
Globus is a topic of interest for many specialties including otorhinolaryngology, gastroenterology and psychiatry/psychosomatic medicine, but, although many hypotheses have been suggested, key questions about its aetiology remain. This Review provides an overview of the extensive literature concerning this topic and discusses the quality of the evidence to date. Globus has been associated with oropharyngeal structural lesions, upper oesophageal sphincter disorders, oesophageal disorders, GERD, psychosocial factors and psychiatric comorbidity. However, findings are often contradictory and the literature remains highly inconclusive. Indeed, with the exception of patients with structural-based globus, the Rome III criteria for functional globus only apply to a subgroup of patients with idiopathic globus. In clinical reality, there exists a group of patients who present with idiopathic (nonstructural) globus, but nevertheless have dysphagia, odynophagia or GERD-exclusion criteria for globus diagnosis according to Rome III. The symptomatology of patients with globus might be broader than previously thought. It is therefore crucial to approach globus not from one single perspective, but from a multifactorial point of view, with focus on the coexistence and/or interactions of different mechanisms in globus pathogenesis. This approach could be translated to clinical practice by adopting a multidisciplinary method to patients presenting with globus.
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9
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Bajbouj M, Meining A, Schmid RM. Endoscopic diagnosis and treatment of inlet patch: Justification, techniques, and results. TECHNIQUES IN GASTROINTESTINAL ENDOSCOPY 2014. [DOI: 10.1016/j.tgie.2013.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Manabe N, Tsutsui H, Kusunoki H, Hata J, Haruma K. Pathophysiology and treatment of patients with globus sensation--from the viewpoint of esophageal motility dysfunction. J Smooth Muscle Res 2014; 50:66-77. [PMID: 26081369 PMCID: PMC5137314 DOI: 10.1540/jsmr.50.66] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Accepted: 09/02/2014] [Indexed: 12/12/2022] Open
Abstract
"Globus sensation" is often described as the sensation of a lump in the throat associated with dry swallowing or the need for dry swallowing, which disappears completely during eating or drinking and for which no organic cause can be established. Due to the uncertain etiology of "globus sensation", it remains difficult to establish standard treatment strategies for affected patients. Lately most attention has been focused on gastroesophageal reflux disease and several reports have indicated that there is a close relationship between esophageal acid reflux and globus sensation. Nowadays, empirical therapy with a high dose of a proton pump inhibitor (PPI) is considered to be indicated for patients with globus sensation, after excluding organic diseases such as pharyngeal cancer, Zenker's diverticulum, or thyroid enlargement. If patients are nonresponsive to PPI therapy, evaluation of esophageal motility should be done. In our recent study, 47.9% had abnormal esophageal motility, with the most common esophageal motility abnormality being an ineffective esophageal motility in PPI-resistant patients with globus sensation. This suggests that prokinetics alone or adding prokinetics to PPI should be the treatment to be considered, although few studies have investigated the efficacy of prokinetics in the treatment of patients with globus sensation. If patients without any esophageal motility dysfunctions are nonresponsive to PPI therapy, either cognitive-behavioral therapy, anti-depressants, or gabapentin could be helpful, although further well-designed, randomized controlled large-scale studies will be necessary to determine the effectiveness of each treatment strategy on patients with globus sensation.
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Affiliation(s)
- Noriaki Manabe
- Division of Endoscopy and Ultrasonography, Department of
Clinical Pathology and Laboratory Medicine, Kawasaki Medical School, Kurashiki,
Japan
| | - Hideaki Tsutsui
- Division of Gastroenterology, Department of Internal
Medicine, Kawasaki Medical School, Kurashiki, Japan
| | - Hiroaki Kusunoki
- Department of Health Care Medicine, Kawasaki Medical School,
Kurashiki, Japan
| | - Jiro Hata
- Division of Endoscopy and Ultrasonography, Department of
Clinical Pathology and Laboratory Medicine, Kawasaki Medical School, Kurashiki,
Japan
| | - Ken Haruma
- Division of Gastroenterology, Department of Internal
Medicine, Kawasaki Medical School, Kurashiki, Japan
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Rosztóczy A, Izbéki F, Németh IB, Dulic S, Vadászi K, Róka R, Gecse K, Gyökeres T, Lázár G, Tiszlavicz L, Wittmann T. Detailed esophageal function and morphological analysis shows high prevalence of gastroesophageal reflux disease and Barrett's esophagus in patients with cervical inlet patch. Dis Esophagus 2012; 25:498-504. [PMID: 22107367 DOI: 10.1111/j.1442-2050.2011.01281.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Although the pathogenesis of cervical inlet patch (CIP) is not fully understood, most authors consider it as a congenital abnormality, whereas others surmise it to be related to gastroesophageal reflux disease (GERD). We aimed to evaluate esophageal function and the prevalence of GERD and Barrett's esophagus in patients with CIP. GERD is defined by the presence of erosive esophagitis or an abnormal pH monitoring. Seventy-one consecutive patients with endoscopic and histological evidence of CIP were prospectively evaluated. Esophageal symptom analysis, 24-hour simultaneous biliary reflux and double-channel pH-monitoring, and esophageal manometry were carried out in 65/71 (92%) patients and in 25 matched controls. Six patients were not suitable for testing and were, therefore, excluded. The histological evaluation of the heterotopic islands showed cardia and/or oxyntic mucosa in 64/65 (98%) patients and specialized intestinal metaplasia (SIM) in one patient (2%). The cardia and/or oxyntic mucosa was accompanied by focally appearing pancreatic acinar metaplasia and pancreatic ductal metaplasia in 7/64 (11%) and in 1/64 (2%), superficial mucous glands in 6/64 (9%), and SIM in 2/64 (3%) cases. In total, SIM was present in three patients (5%), and one of them had low-grade dysplasia. At the gastroesophageal junction, 28 (43%) patients had columnar metaplasia, including nine (14%) patients with SIM. Erosive esophagitis was present in 37 (57%) cases. Thirty-two patients (49%) had abnormal acid reflux in the distal and 25 (38%) in the proximal esophagus. Abnormal biliary reflux was present in 25 (38%) cases. On the basis of endoscopic and pH studies, GERD was established in 44/65 (68%) patients. Typical reflux symptoms were common (33/65, 51%). The combined 24-hour biliary and double-channel pH-monitoring detected significantly more significant acidic reflux at both measurement points and significantly longer bile exposure time in the distal esophagus in patients with CIP. Acid secretion in the CIP was detected in three (5%) cases. Esophageal manometry revealed decreased LES pressure and prolonged relaxation with decreased peristaltic wave amplitude, and an increased number of simultaneous contractions in the esophageal body. The detailed evaluation of the esophageal morphology and function in subjects with CIP showed a high prevalence of GERD and Barrett's esophagus. Further studies are needed to evaluate whether combined acidic and biliary reflux is able to promote similar histomorphological changes in the CIP, as it is shown distally in patients with Barrett's esophagus.
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Affiliation(s)
- A Rosztóczy
- First Department of Medicine, Albert Szent-Györgyi Medical Centre, University of Szeged, Szeged State Health Centre, Budapest, Hungary.
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Lee BE, Kim GH. Globus pharyngeus: a review of its etiology, diagnosis and treatment. World J Gastroenterol 2012; 18:2462-2471. [PMID: 22654443 PMCID: PMC3360444 DOI: 10.3748/wjg.v18.i20.2462] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2011] [Revised: 01/30/2012] [Accepted: 03/09/2012] [Indexed: 02/06/2023] Open
Abstract
Globus is a persistent or intermittent non-painful sensation of a lump or foreign body in the throat. It is a commonly encountered clinical condition that is usually long-lasting, difficult to treat, and has a tendency to recur. Furthermore, due to the uncertain etiology of globus, it remains difficult to establish standard investigation and treatment strategies for affected patients. As a first step for managing globus, careful history taking and nasolaryngoscopy are essential. Given the benign nature of the condition and the recent notion that gastroesophageal reflux disease is a major cause of globus, empirical therapy with a high dose of proton pump inhibitors is reasonable for patients with typical globus. If patients are nonresponsive to this therapy, definitive assessments such as endoscopy, multichannel intraluminal impedance/pH monitoring, and manometry should be considered. Speech and language therapy, anti-depressants, and cognitive-behavioral therapy can be helpful in patients whose symptoms persist despite negative investigations.
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13
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Neumann WL, Luján GM, Genta RM. Gastric heterotopia in the proximal oesophagus ("inlet patch"): Association with adenocarcinomas arising in Barrett mucosa. Dig Liver Dis 2012; 44:292-6. [PMID: 22222950 DOI: 10.1016/j.dld.2011.11.008] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2011] [Revised: 10/27/2011] [Accepted: 11/11/2011] [Indexed: 12/11/2022]
Abstract
BACKGROUND The prevalence of inlet patches and their association with other conditions of the gastrointestinal tract have been studied prospectively in tertiary care facilities; little is known about practice patterns in private outpatient clinics and endoscopy centres. AIMS To assess prevalence, demographic determinants, and associated clinicopathologic features of inlet patches in patients who had oesophagogastroduodenoscopy in outpatient settings throughout the United States. METHODS Retrospective analysis of the clinicopathologic records of 487,229 unique patients who had oesophagogastroduodenoscopy with biopsies between January 2008 and December 2010. RESULTS There were 870 patients with inlet patches with a prevalence of 0.18%. Significant associations included male gender (OR 1.68), dysphagia (OR 1.34), upper respiratory complaints (OR 2.81), globus (OR 5.39) Barrett oesophagus (OR 1.55), and adenocarcinomas arising in Barrett mucosa (OR 5.64). CONCLUSIONS The prevalence of inlet patches in a tertiary care setting (0.18%) was considerably lower than reported in prospective studies (3.7% on average). Inlet patches were significantly associated with male gender, dysphagia, upper respiratory complaints, globus, Barrett mucosa, and adenocarcinomas arising in Barrett oesophagus. Further studies will be needed to determine if patients with inlet patches and Barrett mucosa benefit from increased surveillance.
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Hori K, Kim Y, Sakurai J, Watari J, Tomita T, Oshima T, Kondo C, Matsumoto T, Miwa H. Non-erosive reflux disease rather than cervical inlet patch involves globus. J Gastroenterol 2010; 45:1138-45. [PMID: 20582442 DOI: 10.1007/s00535-010-0275-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2010] [Accepted: 06/07/2010] [Indexed: 02/06/2023]
Abstract
BACKGROUND Gastroesophageal reflux is the most favored etiology for globus; however, recent studies suggest that a cervical inlet patch (heterotopic gastric mucosa in the cervical esophagus) involves globus. This study aimed to reveal whether these two conditions were associated with globus. METHODS A prospective cross-sectional survey was conducted for 2116 consecutive patients who underwent esophagogastroduodenoscopy in our hospital. Patients were interviewed about globus sensations and reflux symptoms prior to endoscopy. Non-erosive reflux disease was considered with reflux symptoms without reflux esophagitis. Inlet patch was detected using narrow-band imaging. RESULTS Sixty-three patients were excluded, and of the remaining 2053 patients (1117 male, 61 years old on average), 120 (5.8%) and 284 (13.8%) had globus and inlet patch, respectively. Multivariate analysis (n = 1584) following the exclusion of proton pump inhibitor users revealed that female gender, younger age (<60), inlet patch, and reflux symptoms were independent risk factors for the development of globus; however, reflux esophagitis was an independent factor for reducing the development of globus. In a reanalysis of non-erosive reflux disease instead of reflux symptoms, inlet patch and non-erosive reflux disease were independent risk factors for the development of globus (odds ratio, 2.9 and 12.1, respectively). CONCLUSIONS Non-erosive reflux disease was more closely associated with globus than an inlet patch. Our controversial results indicating a strong association of globus with non-erosive reflux disease and an inverse association of globus with reflux esophagitis may suggest that mechanisms other than gastroesophageal reflux as the etiology, such as an esophageal visceral hypersensitivity, involve globus.
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Affiliation(s)
- Kazutoshi Hori
- Department of Intestinal Inflammation Research, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan.
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Heterotopic gastric mucosal patch of the esophagus is associated with higher prevalence of laryngopharyngeal reflux symptoms. Eur Arch Otorhinolaryngol 2010; 267:1793-9. [PMID: 20437050 DOI: 10.1007/s00405-010-1259-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2009] [Accepted: 04/15/2010] [Indexed: 12/13/2022]
Abstract
Laryngopharyngeal reflux (LPR) is common in clinical practice. Heterotopic gastric mucosal patch of the proximal esophagus (HGMP) is reported to cause LPR symptoms. This study assessed the prevalence of LPR symptoms and correlation with the size of HGMP. Four hundred and sixty-two patients undergoing endoscopy were carefully questioned regarding LPR symptoms experienced in the previous 12 weeks. The size of the HGMP was assessed and documented during endoscopy. Clinicopathological classifications were assigned (types I-V) accordingly. HGMP [median one patch (range 1-3), median size 15 mm [3-35] was detected in 26 (19 HGM type I and 7 HGM type II] patients giving a prevalence of 5.6%. Among the indications, there were significantly more LPR symptoms as referral indications among patients with HGMP. There were no significant differences in the endoscopic findings. On specific enquiries, significantly more HGMP patients had experienced any LPR symptoms (73.1 vs. 25.9%, p < 0.001) specifically chronic cough (p = 0.002), throat discomfort/hoarseness (p < 0.001), globus sensation (p = 0.004), regurgitation (p < 0.001). HGMP patients also had more heartburn (p = 0.001). Larger HGMP (≥ 15 mm) was only associated with more chronic cough (p = 0.022). In conclusion, patients with HGMP have significantly more LPR symptoms. However, most were mild and detected through specific enquiries. Interestingly, the size of HGMP did not significantly affect the prevalence of LPR symptoms.
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Alagozlu H, Simsek Z, Unal S, Cindoruk M, Dumlu S, Dursun A. Is there an association between Helicobacter pylori in the inlet patch and globus sensation? World J Gastroenterol 2010; 16:42-7. [PMID: 20039447 PMCID: PMC2799915 DOI: 10.3748/wjg.v16.i1.42] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To determine the association between Helicobacter pylori (H. pylori) and globus sensation (GS) in the patients with cervical inlet patch.
METHODS: Sixty-eight patients with esophageal inlet patches were identified from 6760 consecutive patients undergoing upper gastrointestinal endoscopy prospectively. In these 68 patients with cervical inlet patches, symptoms of globus sensation (lump in the throat), hoarseness, sore throat, frequent clearing of the throat, cough, dysphagia, odynophagia of at least 3 mo duration was questioned prior to endoscopy.
RESULTS: Cervical heterotopic gastric mucosa (CHGM) was found in 68 of 6760 patients. The endoscopic prevalence of CHGM was determined to be 1%. H. pylori was identified in 16 (23.5%) of 68 patients with inlet patch. Fifty-three patients were classified as CHGM II. This group included 48 patients with globus sensation, 4 patients with chronic cough and 1 patient with hoarseness. All the patients who were H. pylori (+) in cervical inlet patches had globus sensation.
CONCLUSION: Often patients with CHGM have a long history of troublesome throat symptoms. We speculate that disturbances in globus sensation are like non-ulcer dyspepsia.
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Abstract
PURPOSE OF REVIEW There is no standard protocol for managing globus pharyngeus. Checking the recent developments in this field regularly is of paramount importance. RECENT FINDINGS The commonest symptoms for which proton pump inhibitors are prescribed are globus (73%), followed by choking episodes (66%) and chronic cough (62%). Opinions remain divided about the role of upper esophageal sphincter hypertonicity in globus sensation. Upper aerodigestive tract malignancy is rare and must be excluded. Hypertrophy of the base of the tongue, heterotopic gastric mucosa, curled epiglottis, thyroid enlargement, rare benign or malignant tumors of the pharynx, excessive tension and Eagle's syndrome are possible causes. Flexible endoscopy is a frequently used examination, but there is a 'blind zone' under any upper aerodigestive tract malignancy, requiring rigid endoscopy for some indications. Barium swallow pharyngoesophagography should not be requested systematically for cancer detection. Dual-probe 24 h pH monitoring can help in the diagnosis of reflux. Impedance recording can be useful for the detection of acidic and nonacidic liquid and mist reflux events. Manometric measurements are consistent. Laryngopharyngeal symptoms, such as throat clearing, hoarseness, cough, and globus pharyngeus, are slower to resolve than esophageal symptoms. Nocturnal recovery of gastric acid secretion was demonstrated even with proton pump inhibitors. The symptoms disappeared with an additional H2 receptor antagonist. SUMMARY More awareness is required for patients complaining of globus pharyngeus.
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