Bangladesh Journal of Psychiatry. June, 1995, 7, 1, 32 GLOBUS HYSTERICUS — AN OVERVIEW Anwarul Haider1, M S I Mullick2, Md Shakhawat Islam3 Introduction Globus hystericus, Globus pharynges, Functional no abnormality7. The condition may be due to dysphagia, Globus syndrome are synonymous1. spasm of upper oesophageal sphincter. Many of It is a pscyhogenic disorder of alimentary tract the patients have reflux oesophagities. extremely common, the cause is poorly Oesphageal reflux due to abnormality in cardia understood, indeed may be relieved by may produce vague upper end symptoms, swallowing food or drink, occurs in tense anxious antacids reported to help if this is the case589. individuals23. Globus hystericus should not be diagnosed until an organic lesion especially a malignancy has been excluded10, all other causes of dysphagia Natural History : has to be excluded carefully. The patient often Persistent feeling or sensation of a lump in the admits to psychological stress or cancer phobia11. throat, usually in mid line, localised just above An attempt should be made to offer insight in the the supra steranl notch around the level of cricoid nature of the problem, a detail history, careful cartilage, is the commonest complain, mainly examination with x-ray if appropriate will help to occurs in anxious, middle aged, menopausal reassure a certain number of patients. A history ladies34. There is interference with swallowing but of friends or relatives with throat disease requires no true dysphagia for solid & liquid and the sympathetic probing12. symptoms often noticeable in empty swallowing One also has to remember that even most of saliva, are often diagnosed as globus if on neurotic patient, however on rare occasions is examination nothing found5. The symptoms found to have a serious disorder present14. brought by or made worse by anxiety, have no Recent bereavement is often relevant7. It is other throat symptoms, no loss of weight, no important to request psychiatric attention for those hoarseness of voice, no sore throat6. who need it. Serious underlying emotional disturbances requires expert psychiatric Diagnosis : evolution811. Globus is functional though cineradiography study Early Carcinoma or Pharyngeal web must also may show abnormalities in rhythm of swallowing, be excluded. Pharyngeal Pouch may be preceded Ba-sv'allow & Ba-meal & oesophagoscopy reveal by a globus syndrome due to hypertonic cricophryngeous3. Hiatus hernia is a common problem and measuring the pH in the oesophagus is helpful9. ’Assistant Prof. of Otolaryngology, IPGMR, Dhaka. Examination usually reveal no abnormality, the 2Assistant Prof. of Psychiatry, IPGMR, Dhaka. condition may be due to spasm of pharyngeal 3Senior Clinical Psychologist, Institute of Mental Health constrictor muscles, but some patients on Research, Dhaka Medical College, Dhaka. examination reveals reflux oesophagities12. Every Globus Hystericus an Overview Bangladesh Journal of Psychiatry. June, 1995,7, 1, 33 one should have a Ba-swallow and of the oesophagus is irritated because of reflux oesophagoscopy if symptom persists. Study by than the cricopharyngeous goes into spasm12. oesophageal manometry may be performed2. The diagnosis should never be made if the patient Management: has difficulty in swallowing solid food, such a patient has Cancer until proved otherwise5. Globus is diagnosed much less now than formerly, because it has been realised that Some cases are easy and safe to diagonse as oesophagities and reflex sapasm of globus if there is an obvious emotional precipitating cause The difficult cases are those cricopharyngeus can mimic the symptoms6. In this in which there is no obvious psychological cause7, cases antacids will help the globus symptoms. In great care must be taken not to miss an eraly the true globus cases reassurance that no organic carcinoma, in the Latter group oesophagoscopy disease or cancer present helps the patient to must be done inspite of a negative barium study8. accommodate to the symptoms, which will This is a diagnosis by exclusion9. usually be self limiting. Management is by reassurance, anxiolytices, psychotherapy and Acid reflux or cricopharyngeal spasm does not treatment of underlying cause viz psychogenic appear to have significant relationship thus or organic14 7'11'12. casting doubt, that "globus syndrome" due to reflux oesophagities. It now appears that the old name of globus hystericus while semantically Conclusion : wrong was never, was nearer the truth9. Globus is not uncommon in clinical practice in Globus syndrome versus hypopharygeal tumour our country, it should be kept in mind in evaluating : Diagnosis of early cases presents difficulty, the the patients of dysphagia. patient complains of feeling of some thing in throat round the level of cricoid12. Globus hystericus a differential diagnosis of patterson - brown kelly References : syndrome, it can produce sore throat, similar local 1. Col-man HB, Simpson H. Disease of the nose symptoms. Middle aged menopausal ladies may throat and ear, 15th ed, Churchill Living Stone, have hiatus hernia or they may have globus England. 1984; 64. hystericus a conditon in which they focus their 2. Gray FR, Hawthorne M. Synopsis of problem - usually emotional ones on to their otolaryngology, 5th ed, John Wrights and sons Ltd., Bristol, 1992; 339-86. throats2. 3. Linfordrees WL. A short text book of Psychiatry, Now it is realized that there are many causes for 2nd ed, The English Language book society & this, other than psycho- somatic one, although Hodderand Stoughton, London, 1989; 103-7. this remain the commonest cause, the other 4. Pracy R, Sieglerj, Stell PM. A short text book of causes whose are differential diagnosis are hiatus ear nose and throat, 2nd ed, the English hernia with reflux, cervical osteo phytosis, Language Book society and Hodder and patterson brown kelly syndrome, thyroid swelling/ Stoughton, London, 1993; 94 : 127. nodule, pharyngeal pouch, post cricoid 5. Maran AGD, Logan turner's disease of the nose, Carcinoma, early carcinoma or pharyngeal, throat and ear, 10th ed, KM Varghe KM Company, cricopharyngeal spasm5-711. Edinburgh, 1992; 97-98, 118. The diagnosis is based on history, examination, 6. Maron AGD, The new medicine, otolaryngology blood film, Ba-swallow and meal4. If the lower part vol-4, ELBS London, 1992; 78-83. Globus Hystericus an Overview Bangladesh Journal of Psychiatry. June, 1 995, 7, 1, 34 7. Way WL, Schaubert VL. Current surgical with symptomatic gastro-oesophageal reflex, diagnosis and treatment, 9th ed. A Lange medical GUT, 1988;29:1020-22. book Prentic hall international Inc. New York, 10. Suturb K & Hawarth M. Globus Pharyngis, Br J of 1990; 403-4. Psychiatry, 1988; 21 : 97- 99. 8. John Macleod (editor), Davidsons Principles and 11. Hall L and Pebrick H. Globus Syndrome, Am J of Practic of Medicine, 15th ed. ELBS, Churchill Psychiatry, 1979; 83 : 78-88. Livings Stone, London. 1992; 543-52. 12. Withe D. Pathogenesis of Gastro oesophageal 9. Dent J, Mathur HN. Mechanisms of lower reflux disease, Am J of Radiology, 1988; 151-9. oesophageal sphincter in competence in patients.