title: Non-erosive reflux disease rather than cervical inlet patch involves globus.
abstract: 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.
authors.affiliation: Department of Intestinal Inflammation Research, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan. k-hori@hyo-med.ac.jp
authors.forename: Kazutoshi
authors.initials: K
authors.lastname: Hori
authors.forename: Yongmin
authors.initials: Y
authors.lastname: Kim
authors.forename: Jun
authors.initials: J
authors.lastname: Sakurai
authors.forename: Jiro
authors.initials: J
authors.lastname: Watari
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Tomita
authors.forename: Tadayuki
authors.initials: T
authors.lastname: Oshima
authors.forename: Chizuko
authors.initials: C
authors.lastname: Kondo
authors.forename: Takayuki
authors.initials: T
authors.lastname: Matsumoto
authors.forename: Hiroto
authors.initials: H
authors.lastname: Miwa
mesh_terms: 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