title: Supragastric belch may be related to globus symptom - a prospective clinical study.
abstract: The etiology of globus is poorly understood. It is controversial, whether gastroesophageal reflux disease (GERD) has a role in globus. To investigate the possible esophageal background of this symptom, we performed transnasal esophagoscopy (TNE), high-resolution manometry (HRM), and 24-h multichannel intraluminal impedance (MII) and pH monitoring on globus patients.
  
  
  
  Thirty consecutive patients were referred to Helsinki University Hospital, Department of Otorhinolaryngology - Head and Neck Surgery for treatment of globus; 24 consecutive patients with difficult reflux symptoms from the Department of Surgery served as controls. We compared the results of the patient groups in endoscopies, HRM, and 24-h MII-pH monitoring.
  
  
  
  In MII monitoring, globus patients had supragastric belch (6/20, 30% vs 1/24, 4%; p = 0.038) more often than controls. Total reflux time was higher in controls (p = 0.004), and they had more acid reflux events (p = 0.002) in MII, but between groups, the number of non-acid reflux events was similar. In pH monitoring, DeMeester score and total pH <4 time were higher in controls (P < 0.001). In HRM, the upper esophageal sphincter (UES) mean basal and residual pressures did not differ.
  
  
  
  Supragastric belch was more common in globus patients, suggesting the possible role of this condition in globus sensation. However, globus patients in this series had no acid or non-acid GERD or elevated UES pressure.
authors.affiliation: Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
authors.forename: P
authors.identifier: 0000-0003-0106-0163
authors.initials: P
authors.lastname: Nevalainen
authors.affiliation: Department of Clinical Physiology and Nuclear Medicine, Helsinki University Hospital Medical Imaging Centre, Helsinki, Finland.
authors.forename: M
authors.initials: M
authors.lastname: Walamies
authors.affiliation: Pathology and Gastroenterological Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
authors.forename: O
authors.initials: O
authors.lastname: Kruuna
authors.affiliation: Department of Gastroenterology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
authors.forename: P
authors.initials: P
authors.lastname: Arkkila
authors.affiliation: Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
authors.forename: L-M
authors.initials: LM
authors.lastname: Aaltonen
mesh_terms: D000328:Adult; D000368:Aged; D004884:Eructation / Q000175:diagnosis* / Q000503:physiopathology*; D050782:Esophageal pH Monitoring / Q000379:methods; D005260:Female; D005764:Gastroesophageal Reflux / Q000175:diagnosis* / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008365:Manometry / Q000379:methods; D008875:Middle Aged; D011446:Prospective Studies; D055815:Young Adult
keywords: 24-h multichannel intraluminal impedance and pH monitoring; globus; high-resolution manometry; supragastric belch; transnasal esophagoscopy