Globus, reflux or perhaps both?
Reviewed by Sangeeta Maini and Bhaskar Ram

We rarely do an ENT clinic without encountering a patient with persistent or recurring feeling of a lump or foreign body in the throat. We are also familiar with patients dreading to hear the C word after the endoscopic examination but paradoxically feeling disappointed when told that all is well. The authors feel that globus can be a symptom of reflux or a functional disorder. Psychological factors underlying globus symptoms are often implicated as many patients report exacerbation of symptoms during emotional stress. Treatment of globus hinges on differentiating the sensation as a manifestation of gastroesophageal reflux disease (GERD), structural lesions or a motility disorder, from globus as a functional disorder. While dysphagia could be part of the manifestations of laryngopharyngeal reflux (LPR), dysphagia can definitely be the result of GERD and GERD-related complications. GERD can result in alterations of the upper oesophageal sphincter (UES) and its reflexes, including an increase in UES pressure augmented by acidity. The connection between dysphagia and LPR specifically is not clear. However GERD is more globally associated with dysphagia, particularly with reflux oesophagitis, peptic strictures, Schatzki’s rings, and long-term reflux complications, like Barrett’s oesophagus with oesophageal cancer. There is evidence that GERD results in the UES becoming shorter and hypotonic. Changes in the oesophago-UES contractile and relaxation reflexes may allow refluxate to breach the UES barrier, resulting in LPR. In addition, they also comment that the alterations and loss of reflexes designed to clear the oesophagus of refluxate may also contribute to LPR. This paper is a useful read in further understanding this common symptom presentation in our general ENT clinics.

What’s with the Lump in the Throat? Globus, Dysphagia, and the Role of the Upper Esophageal Sphincter in Laryngopharyngeal Reflux Disease.
Koutroumpakis F, Richards D.
OTOLARYNGOL CLIN NORTH AM
2025;58(3):465–74.