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

Poovipirom, Natthanan; Ratta‐apha, Woraphat; Maneerattanaporn, Monthira; Geeratragool, Tanawat; Chuenprapai, Pritsana; Leelakusolvong, Somchai

doi:10.1111/nmo.14500

Cited by 3 publications

(7 citation statements)

References 40 publications

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“…Although the phenomenon of anxiety among patients with pharyngitis has been well described in previous clinic studies ( 34 , 35 ), the precise cell type–specific organization and functional pathways responsible for modulating anxiety through this pharynx-to-brain axis have remained unknown. This study defines a pharynx-to-brain axis (pharynx→NJP→NTS NE →vBNST) through which pharyngeal inflammation can induce anxiety-like behaviors in mice.…”

Section: Discussionmentioning

confidence: 99%

A pharynx-to-brain axis controls pharyngeal inflammation–induced anxiety

Zhao,

Zhang,

Dong

et al. 2024

Proc. Natl. Acad. Sci. U.S.A.

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Anxiety is a remarkably common condition among patients with pharyngitis, but the relationship between these disorders has received little research attention, and the underlying neural mechanisms remain unknown. Here, we show that the densely innervated pharynx transmits signals induced by pharyngeal inflammation to glossopharyngeal and vagal sensory neurons of the nodose/jugular/petrosal (NJP) superganglia in mice. Specifically, the NJP superganglia project to norepinephrinergic neurons in the nucleus of the solitary tract (NTS NE ). These NTS NE neurons project to the ventral bed nucleus of the stria terminalis (vBNST) that induces anxiety-like behaviors in a murine model of pharyngeal inflammation. Inhibiting this pharynx→NJP→NTS NE →vBNST circuit can alleviate anxiety-like behaviors associated with pharyngeal inflammation. This study thus defines a pharynx-to-brain axis that mechanistically links pharyngeal inflammation and emotional response.

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Section: Discussionmentioning

confidence: 99%

A pharynx-to-brain axis controls pharyngeal inflammation–induced anxiety

Zhao,

Zhang,

Dong

et al. 2024

Proc. Natl. Acad. Sci. U.S.A.

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“…Treatments include strategies to improve vocal hygiene and minimise excess voice demands, as well as targeted therapies to normalise aberrant motor patterns or tension63–65 and address sensory components which may drive phonotraumatic symptoms 66–68. Patients may also be provided with reflux therapies in a ‘cover all’ approach.…”

Section: Diagnostic and Clinical Classifications Of Uctsmentioning

confidence: 99%

“…Treatments for FTD restore normal sensory and motor aerodigestive functions and may directly target potential precipitants or symptoms. Non-pharmacological interventions include sensory and motor rehabilitation programmes63 and other behavioural interventions 116 117. On the pharmacological front, neuromodulators and antidepressants may mitigate sensory and motor irregularities15 64 67 85 91 118 and bolster normal functions by addressing central adaptations and psychosomatic factors 10 11 59 119…”

Section: Diagnostic and Clinical Classifications Of Uctsmentioning

confidence: 99%

“…Psychometric screening and behavioural interventions: The brain–gut connection in DGBI has highlighted the value of behavioural interventions for persistent non-structural symptoms, including throat symptoms 63 110 117 142 148–151. Psychological and behavioural interventions in the management of irritable throat symptoms therefore warrants further consideration.…”

Section: Taxonomy and Terminology Of Ucts And Related Diagnosesmentioning

confidence: 99%

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Practical multidisciplinary framework for the assessment and management of patients with unexplained chronic aerodigestive symptoms

Quigley,

Mistry,

Vasant

et al. 2023

BMJ Open Gastroenterol

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ObjectivePatients experiencing unexplained chronic throat symptoms (UCTS) are frequently referred to gastroenterology and otolaryngology outpatient departments for investigation. Often despite extensive investigations, an identifiable structural abnormality to account for the symptoms is not found. The objective of this article is to provide a concise appraisal of the evidence-base for current approaches to the assessment and management of UCTS, their clinical outcomes, and related healthcare utilisation.DesignThis multidisciplinary review critically examines the current understanding of aetiological theories and pathophysiological drivers in UCTS and summarises the evidence base underpinning various diagnostic and management approaches.ResultsThe evidence gathered from the review suggests that single-specialty approaches to UCTS inadequately capture the substantial heterogeneity and pervasive overlaps among clinical features and biopsychosocial factors and suggests a more unified approach is needed.ConclusionDrawing on contemporary insights from the gastrointestinal literature for disorders of gut–brain interaction, this article proposes a refreshed interdisciplinary approach characterised by a positive diagnosis framework and patient-centred therapeutic model. The overarching aim of this approach is to improve patient outcomes and foster collaborative research efforts.

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“…GS, more commonly known as the feeling of a “lump in throat”, is a FSS with lifetime prevalence reports of 9.1–21.5% 6 , 7 . The exact pathophysiology underlying GS is still unclear 8 and a current literature review 9 suggests a complex and multiform etiology. Both somatic (i.e., gastroesophageal reflux disorder, laryngopharyngeal reflux, esophageal motor disorders, and upper esophageal sphincter abnormalities) and psychological factors, including stress, have been suggested to contribute to GS.…”

mentioning

confidence: 99%

Treatment-associated network dynamics in patients with globus sensations: a proof-of-concept study

Imperiale,

Lieb,

Meinlschmidt

2023

Sci Rep

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In this proof-of-concept study, we used a systems perspective to conceptualize and investigate treatment-related dynamics (temporal and cross-sectional associations) of symptoms and elements related to the manifestation of a common functional somatic syndrome (FSS), Globus Sensations (GS). We analyzed data from 100 patients (M = 47.1 years, SD = 14.4 years; 64% female) with GS who received eight sessions of group psychotherapy in the context of a randomized controlled trial (RCT). Symptoms and elements were assessed after each treatment session. We applied a multilevel graphical vector-autoregression (ml GVAR) model approach resulting in three separate, complementary networks (temporal, contemporaneous, and between-subject) for an affective, cognitive, and behavioral dimension, respectively. GS were not temporally associated with any affective, cognitive, and behavioral elements. Temporally, catastrophizing cognitions predicted bodily weakness (r = 0.14, p < 0.01, 95% confidence interval (CI) [0.04–0.23]) and GS predicted somatic distress (r = 0.18, p < 0.05, 95% CI [0.04–0.33]). Potential causal pathways between catastrophizing cognitions and bodily weakness as well as GS and somatic distress may reflect treatment-related temporal change processes in patients with GS. Our study illustrates how dynamic NA can be used in the context of outcome research.

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

Cited by 3 publications

References 40 publications

A pharynx-to-brain axis controls pharyngeal inflammation–induced anxiety

A pharynx-to-brain axis controls pharyngeal inflammation–induced anxiety

Practical multidisciplinary framework for the assessment and management of patients with unexplained chronic aerodigestive symptoms

Treatment-associated network dynamics in patients with globus sensations: a proof-of-concept study

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