Comparison of esophageal motility in gastroesophageal reflux disease with and without globus sensation

Tang, Yuming; Huang, Jia; Zhu, Ying; Qian, Aihua; Xu, Bo; Yao, Weiyan

doi:10.17235/reed.2017.4449/2016

Cited by 6 publications

(4 citation statements)

References 24 publications

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“…Studies focusing on UES motility in LPR patients are limited and controversial. A retrospective study that compared suspected LPR patients with typical GERD patients has revealed that LPR was characterized by higher UES residual pressure . Findings on UES motility were further supported by the efficacy of UES assist device in the patients with laryngeal symptoms .…”

Section: Discussionmentioning

confidence: 90%

A study of proximal esophageal baseline impedance in identifying and predicting laryngopharyngeal reflux

Chen

Liang

Zhang

et al. 2020

J of Gastro and Hepatol

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Background and Aim: Laryngopharyngeal reflux (LPR) is caused by the reflux of gastric contents beyond the esophagus into the larynx and pharynx. However, upper esophageal sphincter (UES) motility and proximal esophagus reflux parameters are poorly studied. This study aims to explore the characteristics of UES motility and reflux parameter among LPR patients. Methods: Patients with laryngopharyngeal symptoms only (L), patients with laryngopharyngeal symptoms and typical esophageal symptoms (L + E), patients with typical esophageal symptoms only (E), and healthy controls (H) were retrospectively included. Physiological profiles were studied and compared among groups using both high-resolution manometry and pH-impedance monitoring, including UES basal pressure, residual pressure, relaxation duration time, recovery time, the time to nadir pressure, UES length, proximal contractile integral, and proximal mean nocturnal baseline impedance (MNBI). Patients' symptom outcomes were also analyzed. Results: A total of 242 patients were included. Proximal MNBI was significantly lower in patients with both laryngopharyngeal and esophageal symptoms (17 cm above low esophageal sphincter [LES]: L vs L + E vs E vs H = 3689.7 vs 2500.0 vs 3073.0 vs 3996.0; 15 cm above LES: L vs L + E vs E vs H = 3155.9 vs 2553.4 vs 3198.9 vs 2985.2; P < 0.001). Patients responded to proton pump inhibitor treatment also had lower proximal MNBI than those who did not (17 cm above LES: 1834.0 vs 3500.0; 15 cm above LES: 1946.5 vs 3432.6; P < 0.001). Conclusion: Decreased proximal MNBI can not only identify LPR patients but also predict patients' symptom outcomes.

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Section: Discussionmentioning

confidence: 90%

A study of proximal esophageal baseline impedance in identifying and predicting laryngopharyngeal reflux

Chen

Liang

Zhang

et al. 2020

J of Gastro and Hepatol

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“…Esophageal motor abnormalities, particularly pertaining to the upper esophageal sphincter (UES) have been described in globus, but it remains unclear if the findings are causative of the symptom, or a consequence of concurrent anxiety. A reactive, hyperdynamic UES with respiration, 21 high UES resting pressures, 22 and elevated UES postswallow residual pressures 23,24 have been reported. There are limited data demonstrating that a lowering of UES pressure with neuromodulator therapy (paroxetine and amitriptyline) can be associated with improvement in globus symptoms 25 .…”

Section: Etiology Of Globusmentioning

confidence: 97%

ESNM/ANMS Review. Diagnosis and management of globus sensation: A clinical challenge

Zerbib

Rommel

Pandolfino

et al. 2020

Neurogastroenterology Motil

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Globus is a non‐painful sensation of a tightness or a lump/foreign body in the throat that is not associated with dysphagia and may actually improve during meals. While several otorhinolaryngologic, thyroid, and esophageal disorders have been linked to globus, cause‐and‐effect relationships are difficult to establish. Consequently, though part of the evaluation, objective otorhinolaryngologic and esophageal testing is often negative. The presence of alarm symptoms, particularly pain, weight loss, dysphagia, or odynophagia is indications for objective testing. A diagnosis of idiopathic globus requires exclusion of pharyngeal, laryngeal, and esophageal disorders with laryngoscopy, endoscopy, high‐resolution manometry, barium radiography, and/or ambulatory reflux monitoring. A trial of acid‐suppressive therapy may be reasonable in the absence of alarm symptoms, especially if concurrent reflux symptoms are identified. Ablation of heterotopic gastric mucosa in the proximal esophagus has been reported to improve globus symptoms. Beyond these specific approaches, further management of idiopathic globus consists of reassurance, neuromodulators, and complementary approaches. Globus has a benign course with no long‐term consequences, and the overall prognosis is good as the magnitude of symptoms may decline over time.

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“…104 Those globus patients who also have GORD may also have a longer UOS zone. 105 Repeated reactive dry swallowing and/or throat clearing might contribute to these observations, which may have a historical correlate in the so-called 'inferior constrictor strain swallow' described by Gray. 106 There is recent interest in ambulatory 24-hour oropharyngeal aerosol acid exposure assessment, which was used in 101 patients with GORD symptoms and cough, hoarseness, asthma symptoms or globus sensation alongside concomitant oesophageal pH monitoring.…”

Section: Update On Ph-metry and Manometry In Throat Symptomsmentioning

confidence: 99%

Lansoprazole for persistent throat symptoms in secondary care: the TOPPITS RCT

Wilson

Stocken

Watson

et al. 2021

Health Technol Assess

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Background Persistent throat symptoms are commonly attributed to ‘laryngopharyngeal reflux’. Despite a limited evidence base, these symptoms are increasingly being treated in primary care with proton pump inhibitors. Objective To assess the value of proton pump inhibitor therapy in patients with persistent throat symptoms. Design This was a double-blind, placebo-controlled, randomised Phase III trial. Setting This was a multicentre UK trial in eight UK ear, nose and throat departments. Participants A total of 346 participants aged ≥ 18 years with persistent throat symptoms and a Reflux Symptom Index score of ≥ 10, exclusive of the dyspepsia item, were recruited. Intervention Random allocation (1 : 1 ratio) to either 30 mg of lansoprazole twice daily or matched placebo for 16 weeks. Main outcome measure Symptomatic response (i.e. total Reflux Symptom Index score after 16 weeks of therapy). Results A total of 1427 patients were screened and 346 were randomised. The mean age was 52 years (standard deviation 13.7 years, range 20–84 years); 150 (43%) participants were male and 196 (57%) were female; 184 (53%) participants had a mild Reflux Symptom Index minus the heartburn/dyspepsia item and 162 (47%) had a severe Reflux Symptom Index minus the heartburn/dyspepsia item. A total of 172 patients were randomised to lansoprazole and 174 were randomised to placebo. Main outcomes A total of 267 participants completed the primary end-point visit (lansoprazole, n = 127; placebo, n = 140), of whom 220 did so between 14 and 20 weeks post randomisation (‘compliant’ group); 102 received lansoprazole and 118 received placebo. The mean Reflux Symptom Index scores at baseline were similar [lansoprazole 22.0 (standard deviation 8.0), placebo 21.7 (standard deviation 7.1), overall 21.9 (standard deviation 7.5)]. The mean Reflux Symptom Index scores at 16 weeks reduced from baseline in both groups [overall 17.4 (standard deviation 9.9), lansoprazole 17.4 (standard deviation 9.9), placebo 15.6 (standard deviation 9.8)]. Lansoprazole participants had estimated Reflux Symptom Index scores at 16 weeks that were 1.9 points higher (worse) than those of placebo participants (95% confidence interval –0.3 to 4.2; p adj = 0.096), adjusted for site and baseline severity. Secondary outcomes Ninety-five (43%) participants achieved a Reflux Symptom Index score in the normal range (< 12) at 16 weeks: 42 (41%) in the lansoprazole group and 53 (45%) in the placebo group. A total of 226 participants completed the end-of-trial follow-up visit (lansoprazole, n = 109; placebo, n = 117), of whom 181 were ‘compliant’. The mean Reflux Symptom Index scores at 12 months reduced from baseline in both groups [lansoprazole 16.0 (standard deviation 10.8), placebo 13.6 (standard deviation 9.6), overall 14.7 (standard deviation 10.2)]. A total of 87 (48%) participants achieved a Reflux Symptom Index score in the normal range at 12 months: 33 (40%) in the lansoprazole group and 54 (55%) in the placebo group. Likewise, the Comprehensive Reflux Symptom Score and Laryngopharyngeal Reflux – Health Related Quality of Life total scores and subscales all showed very similar changes in the lansoprazole and placebo cohorts at both 16 weeks and 12 months. Limitations Drop-out rate and compliance are issues in pragmatic clinical trials. The Trial Of Proton Pump Inhibitors in Throat Symptoms (TOPPITS) aimed to detect clinically relevant difference with 90% power. The 346 randomised participants reduced to 283 at the primary end point; 267 completed the primary outcome measure, 220 within the protocol time scale. Despite this, the powers to detect the clinically relevant difference in Reflux Symptom Index score at 16 weeks were 82% (compliant comparison) and 89% (pragmatic comparison). The lack of difference between lansoprazole and placebo is generalisable across NHS clinics. Conclusions Participants on lansoprazole did not report significantly better outcomes than participants on placebo on any of the three patient-reported outcome tools (Reflux Symptom Index, Comprehensive Reflux Symptom Score and Laryngopharyngeal Reflux – Health Related Quality of Life). This multicentre, pragmatic, powered, definitive Phase III trial found no evidence of benefit for patients by treating persistent throat symptoms with lansoprazole. Trial registration Current Controlled Trials ISRCTN38578686 and EudraCT number 2013-004249-17. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 3. See the NIHR Journals Library website for further project information.

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Comparison of esophageal motility in gastroesophageal reflux disease with and without globus sensation

Abstract: Globus GERD patients have a higher UES residual pressure, longer LES length, higher LES basal pressure and greater esophageal dysmotility than typical GERD patients. HRM is useful in evaluating esophageal motility of GERD patients.

Cited by 6 publications

References 24 publications

A study of proximal esophageal baseline impedance in identifying and predicting laryngopharyngeal reflux

A study of proximal esophageal baseline impedance in identifying and predicting laryngopharyngeal reflux

ESNM/ANMS Review. Diagnosis and management of globus sensation: A clinical challenge

Lansoprazole for persistent throat symptoms in secondary care: the TOPPITS RCT

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