Globus pharyngeus and the role of barium swallow
Poster No.:
C-0710
Congress:
ECR 2013
Type:
Scientific Exhibit
Authors:
C. Gouw , S. Cherian , R. M. Mendelson ; Utrecht/NL, Perth/AU
Keywords:
Diverticula, Cancer, Barium meal, Fluoroscopy, Gastrointestinal
tract, Ear / Nose / Throat
DOI:
10.1594/ecr2013/C-0710
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Purpose
Globus pharyngeus is a common complaint amongst the general population and accounts
for around 4% of new ENT referrals [1]. It describes the sensation of a lump or tightness
in the throat.
Recently it has been defined as a persistent or intermittent, non-painful sensation of
a lump or foreign body in the throat which occurs even in between meals, in the
absence of dysphagia or odynophagia, gastro-esophageal reflux and histopathology
based esophageal motility disorders. It is required that the above criteria be fulfilled for
the previous three months, with onset of symptoms at least six months before a diagnosis
is made [2].
The exact aetiology of globus remains unknown. Several theories such as
cricopharyngeal spasm [3], gastro-oesophageal and laryngo-pharyngeal reflux [4,5,6,7],
thyroid pathology [8,9], and recently hyperdynamic upper oesophageal sphincter
pressure [10] have been proposed, but not clearly confirmed as cause.
As the causes are not well established, the diagnostic pathways and management are
still a point of debate among ENT clinicians. A large questionnaire in the UK showed that
about 56% of clinicians would request a barium swallow (BS) as further investigation, 61%
a rigid endoscopy and 17.5% a combination of BS and endoscopy [11]. BS studies are
usually performed to exclude malignancies of the upper pharyngo-oesophageal tract and
also for reassurance. A few studies have been published in the literature describing the
added value of BS in the diagnostic pathway of globus pharyngeus [12,13,14,15,16,17].
The aim of this study is to review the value of barium swallow in patients referred from the
Ear, Nose and Throat (ENT) Clinic with the predominant symptom of globus pharyngeus.
Methods and Materials
A review was carried out of radiology request forms for barium swallow (BS) received
from the ENT clinic between 2005 and 2010 in whom "globus pharyngeus" or "lump in
throat" was mentioned as the predominant symptom (54 patients). Two patients were
excluded, one due to a history of radiotherapy to the neck region and the other having
had an incomplete barium swallow study.
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All BS studies were examined using a protocol which allowed assessment of
hypopharyngeal and oesophageal morphological abnormalities, oesophageal motility
and postural gastro-oesophageal reflux (GOR). The studies were performed or
supervised and evaluated by experienced gastrointestinal radiologists.
BS results and clinical information concerning history, ENT examination and
management strategies were obtained from Picture Archiving Communication System
(PACS) and medical records for the remaining 52 patients.
Results
Study group:
•
•
•
•
•
52 patients (18 males; 34 females).
Mean age 57 years (range 24-86).
Only 15/52 (30%) patients had globus sensation als a sole symptom.
37 patients had one or more associated symptoms (Table 1 on page 3).
Complaints lasted on average for 20 months (range 1 month to 10 years).
Barium swallow findings:
•
•
•
•
•
Normal in 23 patients (44%).
In 29 patients (56%) abnormalities were reported (Table 2 on page 4).
8 patients had a combination of a motility disorder or reflux and one or more
structural abnormalities (Fig. 1 on page 5, Fig. 2 on page 7).
GOR (10 patients; 19%) was the most common finding, followed by a hiatus
hernia in 8 patients (Fig. 3 on page 9).
Two patients showed mucosal irregularity of the hypopharynx or
oesophagus.
No patient was diagnosed with malignancy, and none developed malignancy on clinical
follow-up of 3 months to 6 years (mean: 6,9 months).
Images for this section:
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Table 1: 37 patients had associated symptoms. * Some patients had more than one
associated complaint.
Page 4 of 13
Table 2: Barium swallow findings **Some patients had more than one finding.
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Fig. 1: 75 year old male patient. Barium swallow demonstrated considerable dilatation of
the oesophagus down to the gastro- oesophageal junction and an intrathoracic stomach.
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Fig. 2: A 78 year old lady was referred with a main complaint of 'lump in the throat'. Barium
swallow demonstrated prominent cricopharyngeal muscle impression on the posterior
aspect of the oesophagus at C5-C6 level.
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Fig. 3: Barium swallow in this 56 year old lady with globus symptoms revealed a moderate
sized hiatus hernia and a small Schatzki ring.
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Conclusion
Globus sensation as a sole symptom occurs in the minority of patients complaining of
this symptom. Barium swallow in patients with globus pharyngeus often demonstrates
benign abnormalities, most commonly related to the spectrum of GOR. The yield of BS
is low for significant pathology in patients with globus pharyngeus.
References
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and age and sex relationships. Arch Otolaryngol. 1982 Nov;108(11):740-4.
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Watson WC, Sullivan SN. Hypertonicity of the cricopharyngeal sphincter: A
cause of globus sensation. Lancet. 1974 Dec 14;2(7894):1417-9.
4.
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Gastroesophageal reflux, motility disorders, and psychological profiles in the
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12. Alaani A, Vengala S,JohnstonMN. The role of barium swallow in the
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Personal Information
Cornelia Gouw MD, Department of Radiology, University Medical Center Utrecht, Utrecht,
The Netherlands
Sam Cherian MD, Department of Radiology, Royal Perth Hospital, Perth, Australia
Richard Mendelson MD PhD, Department of Radiology, Royal Perth Hospital, Perth,
Australia
Correspondence:
Cornelia Gouw
[email protected]
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