Clinical Characteristics of Patients With Proton Pump Inhibitor-refractory Globus.

Abstract

Background/aims: Globus is often linked with gastroesophageal reflux disease, which influences its treatment strategies. This study aimed to investigate clinical characteristics of patients with refractory proton pump inhibitor (PPI) globus to better understand its etiology.

Methods: Between 2017 and 2023, 123 out of 592 patients with Globus from the Samsung medical center outpatient clinic who were unresponsive to eight weeks of PPI treatment were analyzed. Patients underwent 24-hour esophageal pH monitoring and highresolution manometry (HRM). They were divided into acid reflux, non-acid reflux, and no reflux groups, with basal impedance (BI) measurements taken at 3, 9, and 15 cm along the esophagus. These values were compared against data of healthy volunteers to identify significant differences across groups.

Results: The acid reflux group displayed a median impedance of 1152 Ω at 3 cm, which was significantly lower than the median impedance of the non-acid reflux group (2644 Ω) and the no-reflux group (3083 Ω), highlighting varying degrees of reflux impact (P = 0.015). Most patients in non-acid reflux and no-reflux groups showed higher impedance levels at both 3 cm and 15 cm compared to the first quartile of healthy individuals with significant differences (P = 0.032 and P = 0.029, respectively). There was no notable difference in the average impedance variation between 3 cm and 15 cm in the no-reflux group (P = 0.540).

Conclusions: Reduced proximal BI values compared to distal BI values suggest increased permeability in globus patients. Further studies with a larger cohort of refractory PPI patients and healthy volunteers are needed to explore these findings and their implications on globus etiology.