Clinical Predictors for Response to Proton Pump Inhibitor Treatment in Patients With Globus

Abstract

Background/AimsGlobus is a persistent or intermittent non-painful sensation of a lump or foreign body in the throat. Given the benign nature of the condition and the association of gastroesophageal reflux disease, empirical therapy with proton pump inhibitor seems reasonable for patients with typical globus. The aim of this study was to investigate the clinical predictors for symptom response to short-term proton pump inhibitor treatment in patients with globus symptom.MethodsFifty-four patients with globus symptom were enrolled prospectively. All patients were treated with pantoprazole 40 mg daily for 4 weeks. Treatment response was defined as a > 50% reduction in symptom scores between symptom assessments. Univariate and multivariate logistic regression analysis between responders and non-responders was performed to identify variables predicting response to pantoprazole treatment.ResultsOf the 54 consecutive patients considered, 13 were excluded on the basis of exclusion criteria and/or refusal to participate in the study. Finally, 41 patients were included in this study. After 4-week pantoprazole treatment, 22 patients (53.7%) were classified as responders. On multivariate analysis, the presence of reflux symptom was associated with a higher response rate to 4-week pantoprazole treatment (OR, 68.56; P = 0.043), and long symptom duration (≥ 3 months) were associated with a lower response rate to pantoprazole treatment (OR, 0.03; P = 0.034).ConclusionsPresence of reflux symptom and short symptom duration were independent predictors of responsiveness to 4-week pantoprazole treatment in patients with globus.

Pathophysiology and treatment of patients with globus sensation —from the viewpoint of esophageal motility dysfunction—

“…Our results suggested that the more acid reflux is involved in the etiology of patients with globus sensation, the more effective PPI becomes even though the duration of administration of PPI is relatively short. A recent study by Jeon et al also showed the same results as ours, namely that the presence of reflux symptoms and short symptom duration were independent predictors of responsiveness to 4-week PPI treatment in patients with globus sensation (53). …”

Prediction of effectiveness of potassium-competitive acid blocker and serotonin noradrenaline reuptake inhibitor on abnormal sensation in the throat: use of patient-reported outcome measures (PROMs)

“…All other patients were defined as non-responders. 50% or more decrease was chosen based on the value used in previous studies that examined drug effects on globus sensation [ 19 , 20 ].…”

“…Improvement ratio of somatic distress showed significant correlation with that of the GETS-J pain/swelling subscale There were 14 responders and 17 non-responders, indicating that the overall effective rate of the P-CAB treatment on AST was 45.1%. Pantoprazole (40 mg), one of the PPIs, for four weeks showed an effective rate of 35.7% [19] and 53.7% [20] when the same threshold to determine the responders (> 50% reduction in symptom scores) was used. Our results of P-CAB (45.1%) were comparable with these studies.…”

Treatment outcomes in patients with globus: A randomized control trial of psychoeducation, neuromodulators, and proton pump inhibitors

“…PPI was primarily considered to be the first‐line treatment of globus given that GERD had been suggested to be a major cause. Unfortunately, prior studies using PPI yielded inconsistent outcomes 7,8 . There were a few of trials which proved the benefit of low‐dose tricyclic antidepressants (TCA) such as amitriptyline or selective serotonin reuptake inhibitor (SSRI) such as paroxetine 9–11 .…”