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  • Review Article
  • Published:

The complexity of globus: a multidisciplinary perspective

Nature Reviews Gastroenterology & Hepatology volume 11, pages 220–233 (2014)Cite this article

Subjects

Key Points

  • The literature on globus sensation is extensive, but suffers from several methodological limitations

  • The most frequently presumed causes of idiopathic globus are hypertensive upper oesophageal sphincter, oesophageal motility disorders, cervical inlet patch, GERD and anxiety or depression

  • The aetiology of globus has been a topic of interest for clinicians from otorhinolaryngology, gastroenterology and psychiatry/psychosomatic medicine, but there is a lack of integration of their hypotheses

  • We propose a 'globus neuronal dysfunction model', which suggests that a peripheral neuronal dysfunction is the central cause of globus

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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Figure 1: Schematic representation of a 'globus neuronal dysfunction model'.
Figure 2: Proposed algorithm for clinical management of patients with globus.

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Authors and Affiliations

  1. Department of Neurosciences, ExpORL and Translational Research Center for Gastrointestinal Disorders (TARGID), Herestraat 49 (PO 701), Leuven, 3000, Belgium

    Margot Selleslagh

  2. TARGID, Herestraat 49 (PO 701), Leuven, 3000, Belgium

    Lukas van Oudenhove & Ans Pauwels

  3. TARGID and Department of Gastroenterology, Neurogastroenterology & Motility, Herestraat 49 (PO 701), Leuven, 3000, Belgium

    Jan Tack

  4. Department of Neurosciences, ExpORL and Department of Gastroenterology, Neurogastroenterology & Motility KU Leuven, Herestraat 49 (PO 701), Leuven, 3000, Belgium

    Nathalie Rommel

Authors
  1. Margot Selleslagh
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  3. Ans Pauwels
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  4. Jan Tack
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  5. Nathalie Rommel
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The authors contributed equally to all aspects of this article.

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Supplementary information

Supplementary Table 1

UES resting pressure in globus (DOC 135 kb)

Supplementary Table 2

Prevalence of GERD in patients with globus (DOC 135 kb)

Supplementary Table 3

Acid exposure in globus (DOC 135 kb)

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Selleslagh, M., van Oudenhove, L., Pauwels, A. et al. The complexity of globus: a multidisciplinary perspective. Nat Rev Gastroenterol Hepatol 11, 220–233 (2014). https://doi.org/10.1038/nrgastro.2013.221

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