Non-erosive reflux disease rather than cervical inlet patch involves globus.
BACKGROUND
Gastroesophageal reflux is the most favored etiology for globus; however, recent studies suggest that a cervical inlet patch (heterotopic gastric mucosa in the cervical esophagus) involves globus. This study aimed to reveal whether these two conditions were associated with globus.


METHODS
A prospective cross-sectional survey was conducted for 2116 consecutive patients who underwent esophagogastroduodenoscopy in our hospital. Patients were interviewed about globus sensations and reflux symptoms prior to endoscopy. Non-erosive reflux disease was considered with reflux symptoms without reflux esophagitis. Inlet patch was detected using narrow-band imaging.


RESULTS
Sixty-three patients were excluded, and of the remaining 2053 patients (1117 male, 61 years old on average), 120 (5.8%) and 284 (13.8%) had globus and inlet patch, respectively. Multivariate analysis (n = 1584) following the exclusion of proton pump inhibitor users revealed that female gender, younger age (<60), inlet patch, and reflux symptoms were independent risk factors for the development of globus; however, reflux esophagitis was an independent factor for reducing the development of globus. In a reanalysis of non-erosive reflux disease instead of reflux symptoms, inlet patch and non-erosive reflux disease were independent risk factors for the development of globus (odds ratio, 2.9 and 12.1, respectively).


CONCLUSIONS
Non-erosive reflux disease was more closely associated with globus than an inlet patch. Our controversial results indicating a strong association of globus with non-erosive reflux disease and an inverse association of globus with reflux esophagitis may suggest that mechanisms other than gastroesophageal reflux as the etiology, such as an esophageal visceral hypersensitivity, involve globus.
Hori
Kazutoshi
K
Department of Intestinal Inflammation Research, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan. k-hori@hyo-med.ac.jp
Kim
Yongmin
Y
Sakurai
Jun
J
Watari
Jiro
J
Tomita
Toshihiko
T
Oshima
Tadayuki
T
Kondo
Chizuko
C
Matsumoto
Takayuki
T
Miwa
Hiroto
H
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002828:Choristoma / Q000473:pathology*; D003430:Cross-Sectional Studies; D003680:Deglutition Disorders / Q000209:etiology*; D016145:Endoscopy, Digestive System / Q000379:methods; D004942:Esophagitis, Peptic / Q000503:physiopathology; D005260:Female; D005753:Gastric Mucosa / Q000473:pathology*; D005764:Gastroesophageal Reflux / Q000503:physiopathology* / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011446:Prospective Studies; D012307:Risk Factors; D012737:Sex Factors; D055815:Young Adult