Ever Feel Like Something is Stuck in Your Throat?
The mind-body connection is a fascinating thing. Psychological trauma and stress have uncanny ways of presenting as physical symptoms. One particularly interesting example is globus sensation, which is often described as the feeling that there is a glob of peanut butter stuck in your throat.
The basics
Globus sensation is the feeling that there is a lump or tightness in the throat. It is a diagnosis of exclusion, which is basically a fancy way of saying the symptoms are not due to some other cause, like obstruction, motor disorder, or acid reflux. Historically (and incorrectly) Globus sensation was characterized as a ‘hysterical’ disorder, with the implication being that it was a disorder attributable only to women. This terminology has since been rejected and the prevalence among healthy men and women is now known to be similar. In fact, one of the most fascinating things about globus sensation is just how common it is. An estimated 22% of the general population will experience globus sensation in their lifetime.
The cause of globus sensation isn’t fully understood. Several potential factors have been implicated, including esophageal hypersensitivity, abnormal sphincter muscle tone, and gastroesophageal reflux disease (GERD). Perhaps the most interesting proposed cause, however, is what doctors refer to as ‘psychological abnormalities’.
In the late 1980s and early 1990s, several studies linked globus sensation to neuroticism, introversion, anxiety, and depression. Recent studies have supported early work and have linked globus sensation to other psychological disorders and high-stress situations, such as living in an urban area. It has also been reported that merely being evaluated for globus sensation may improve symptoms through the reduction of patient anxiety. While these studies don’t necessarily prove a cause and effect relationship between globus sensation and affective disorders (association ≠ causation), they do provide a reason to suspect the two are linked.
How is Globus Sensation Diagnosed?
Diagnosis of globus sensation begins with a physical exam and detailed medical history. However, you aren’t likely to receive a definitive diagnosis after your first visit to the doctor. This is because symptoms need to have started at least six months prior to diagnosis and all of the following criteria must be met:
- Structural causes have been ruled out (usually using laryngoscopy or endoscopy)
- The sensation persists between meals for at least three months
- The sensation isn’t associated with swallowing difficulty
- Symptoms aren’t explained by another cause, such as GERD, esophageal inflammation, or motor disorder.
How is Globus Sensation Treated?
There is no ‘gold standard’ for treatment for globus sensation. Initial management usually includes patient reassurance and a 6 to 8-week course of acid suppression therapy. After that, there are several possible options:
- Antidepressants are thought to be useful, especially in patients who have psychiatric disorders, such as panic disorder, somatization, major depression, or agoraphobia. However, the data supporting the use of antidepressants for globus sensation is mostly limited to case reports and retrospective studies. There have been some slightly higher quality studies showing improvements with low-dose tricyclic antidepressants (TCAs), such as amitriptyline and imipramine. These drugs are often among the first antidepressants recommended for globus sensation, though the evidence supporting their use is far from definitive.
- Gabapentin is an antiepileptic (anti-seizure) medication that can be used for a number of different purposes, including neuropathic pain conditions like fibromyalgia. One study found that about two-thirds of patients improved within 3 weeks of starting gabapentin. Of course, this is only one study and there is comparatively less evidence supporting the use of gabapentin than antidepressants. However, gabapentin does have the advantage of being pretty well tolerated by most patients.
- Relaxation therapy may also provide benefits. The current evidence supporting its use for globus sensation is very limited. However, relaxation therapy has been shown to be effective for people with anxiety disorders more generally. This makes it a good option, especially when compared to drugs, which can have unwanted side effects.
Now what?… Some Good News… Maybe?
To recap, globus sensation causes extremely annoying, poorly understood, long-lasting discomfort that doesn’t have a straightforward treatment. If you are someone who is actively experiencing symptoms, this probably isn’t the most reassuring news.
However, there is some good news.
Globus sensation is a benign disorder and often resolves on its own. If you are having symptoms, however, don’t assume they are benign. There are lots of very real, very dangerous diseases that can cause similar symptoms.
If you do get diagnosed with globus sensation, it is important to understand that just because the symptoms are ‘psychological’, doesn’t mean they are any less real or valid. If nothing else, a diagnosis could be an opportunity to take a step back and look inward.
